Healthcare Provider Details

I. General information

NPI: 1144693540
Provider Name (Legal Business Name): AKILA CARES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5160 BALTIMORE NATIONAL PIKE
BALTIMORE MD
21229-1121
US

IV. Provider business mailing address

5160 BALTIMORE NATIONAL PIKE
BALTIMORE MD
21229-1121
US

V. Phone/Fax

Practice location:
  • Phone: 443-618-5558
  • Fax: 410-788-8976
Mailing address:
  • Phone: 410-788-5452
  • Fax: 410-788-8976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMH-1723
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberMH-1723
License Number StateMD

VIII. Authorized Official

Name: MS. DEANA C COOK
Title or Position: PRESIDENT/CEO
Credential:
Phone: 443-618-5558