Healthcare Provider Details

I. General information

NPI: 1114682093
Provider Name (Legal Business Name): REDEEM HEALTHCARE AND MEDICAL SYSTEMS 11 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2127 W PRATT ST
BALTIMORE MD
21223-2244
US

IV. Provider business mailing address

2127 W PRATT ST
BALTIMORE MD
21223-2244
US

V. Phone/Fax

Practice location:
  • Phone: 410-878-0655
  • Fax:
Mailing address:
  • Phone: 410-878-0655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. OSE OKOJIE
Title or Position: OWNER
Credential:
Phone: 443-629-2435