Healthcare Provider Details

I. General information

NPI: 1386257533
Provider Name (Legal Business Name): ALLOVER HEALTHCARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 REISTERSTOWN RD STE 304
BALTIMORE MD
21215-4436
US

IV. Provider business mailing address

5450 REISTERSTOWN RD STE 304
BALTIMORE MD
21215-4436
US

V. Phone/Fax

Practice location:
  • Phone: 443-759-8827
  • Fax: 443-759-8827
Mailing address:
  • Phone: 443-759-8827
  • Fax: 443-759-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: EMIOSHO OKOJIE
Title or Position: CEO
Credential:
Phone: 443-759-8827