Healthcare Provider Details

I. General information

NPI: 1508589128
Provider Name (Legal Business Name): ALLIANZE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 S CONKLING ST
BALTIMORE MD
21224-4201
US

IV. Provider business mailing address

9609 WICKSTEAD CT
PERRY HALL MD
21128-8977
US

V. Phone/Fax

Practice location:
  • Phone: 443-759-1137
  • Fax:
Mailing address:
  • Phone: 443-759-1137
  • 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 Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PHILIP OKOJIE
Title or Position: OWNER
Credential:
Phone: 443-759-1137