Healthcare Provider Details

I. General information

NPI: 1902490154
Provider Name (Legal Business Name): DENOOR HEALTHCARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 W PRATT ST
BALTIMORE MD
21223-2251
US

IV. Provider business mailing address

1935-1937 W PRATT ST FIRST FLOOR
BALTIMORE MD
21223-2251
US

V. Phone/Fax

Practice location:
  • Phone: 571-232-9182
  • Fax:
Mailing address:
  • Phone: 571-232-9182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KAFAYAT OLABISI BELLO-OGUNDIPE
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 571-232-9182