Healthcare Provider Details

I. General information

NPI: 1457946642
Provider Name (Legal Business Name): PREVAIL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 FALLS RD
BALTIMORE MD
21211-1844
US

IV. Provider business mailing address

3730 FALLS RD
BALTIMORE MD
21211-1844
US

V. Phone/Fax

Practice location:
  • Phone: 443-629-8645
  • Fax:
Mailing address:
  • Phone: 443-629-8645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: BENSON MBOCHE
Title or Position: CEO
Credential: PMHNP
Phone: 443-629-8645