Healthcare Provider Details

I. General information

NPI: 1790483311
Provider Name (Legal Business Name): ALTRUIST HEALTHCARE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MAPLEWOOD PARK CT # NA
BETHESDA MD
20814-1743
US

IV. Provider business mailing address

11 MAPLEWOOD PARK CT # NA
BETHESDA MD
20814-1743
US

V. Phone/Fax

Practice location:
  • Phone: 240-476-3080
  • Fax:
Mailing address:
  • Phone: 240-476-3080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. TITILAYO ILORI
Title or Position: CEO
Credential: PMHNP
Phone: 240-476-3080