Healthcare Provider Details

I. General information

NPI: 1659934503
Provider Name (Legal Business Name): ROYAL MINDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 E BALTIMORE ST
BALTIMORE MD
21224-1509
US

IV. Provider business mailing address

3719 E BALTIMORE ST
BALTIMORE MD
21224-1509
US

V. Phone/Fax

Practice location:
  • Phone: 410-943-2424
  • Fax:
Mailing address:
  • Phone: 410-943-2424
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: AL MUFTAU A ADEITE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 240-486-1238