Healthcare Provider Details

I. General information

NPI: 1750979118
Provider Name (Legal Business Name): GREATWAYGROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2021
Last Update Date: 01/01/2021
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 MITCHELLVILLE RD
BOWIE MD
20716-1541
US

IV. Provider business mailing address

1815 MITCHELLVILLE RD
BOWIE MD
20716-1541
US

V. Phone/Fax

Practice location:
  • Phone: 202-710-5665
  • Fax:
Mailing address:
  • Phone: 202-710-5665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. WASIU O YUSUF
Title or Position: PRESIDENT
Credential:
Phone: 202-710-5665