Healthcare Provider Details

I. General information

NPI: 1558225334
Provider Name (Legal Business Name): MAGNOLIA BEHAVIOR HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 WILKENS AVE STE 101
BALTIMORE MD
21229-5204
US

IV. Provider business mailing address

3455 WILKENS AVE STE 101
BALTIMORE MD
21229-5204
US

V. Phone/Fax

Practice location:
  • Phone: 301-473-0954
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIA SHIRIMA
Title or Position: PROVIDER
Credential:
Phone: 240-919-6062