Healthcare Provider Details

I. General information

NPI: 1477498434
Provider Name (Legal Business Name): BISAK RESIDENTIAL RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 WALBROOK AVE
BALTIMORE MD
21217-1247
US

IV. Provider business mailing address

218 E LEXINGTON ST
BALTIMORE MD
21202-3532
US

V. Phone/Fax

Practice location:
  • Phone: 443-231-3996
  • Fax: 443-288-7001
Mailing address:
  • Phone: 334-430-3333
  • Fax: 443-288-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. FLORENCE BISI AKANBI
Title or Position: CEO
Credential: APRN-PMHNP
Phone: 443-858-4111