Healthcare Provider Details

I. General information

NPI: 1255257341
Provider Name (Legal Business Name): SUNBLESS HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E LEXINGTON ST STE 110
BALTIMORE MD
21202-1715
US

IV. Provider business mailing address

110 E LEXINGTON ST STE 110
BALTIMORE MD
21202-1715
US

V. Phone/Fax

Practice location:
  • Phone: 617-475-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: SUNDAY IZIOGO
Title or Position: OWNER
Credential:
Phone: 617-475-2400