Healthcare Provider Details

I. General information

NPI: 1942883699
Provider Name (Legal Business Name): EXCELLENT HEALTHCARE & PSYCHIATRIC REHABILITATION PROGRAM SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 W BELVEDERE AVE UNIT A
BALTIMORE MD
21215-5502
US

IV. Provider business mailing address

4002 W BELVEDERE AVE UNIT A
BALTIMORE MD
21215-5502
US

V. Phone/Fax

Practice location:
  • Phone: 410-984-7411
  • Fax:
Mailing address:
  • Phone: 410-984-7411
  • 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: INNOCENT AKPUAKA
Title or Position: THE PRESIDENT
Credential:
Phone: 410-984-7411