Healthcare Provider Details

I. General information

NPI: 1598697666
Provider Name (Legal Business Name): MIND BEYOND AGE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5438 BRISTOL GREEN WAY
BALTIMORE MD
21229-2105
US

IV. Provider business mailing address

5438 BRISTOL GREEN WAY
BALTIMORE MD
21229-2105
US

V. Phone/Fax

Practice location:
  • Phone: 240-355-1979
  • Fax:
Mailing address:
  • Phone: 240-355-1979
  • 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

VIII. Authorized Official

Name: OLUBUKOLA AMEEN
Title or Position: PRESIDENT
Credential:
Phone: 240-355-1979