Healthcare Provider Details

I. General information

NPI: 1205795218
Provider Name (Legal Business Name): KAYSALEM GLOBAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10714 HEATHER GLEN WAY
BOWIE MD
20720-4296
US

IV. Provider business mailing address

10714 HEATHER GLEN WAY
BOWIE MD
20720-4296
US

V. Phone/Fax

Practice location:
  • Phone: 301-458-9688
  • Fax:
Mailing address:
  • Phone: 301-458-9688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN OLUSOJI
Title or Position: OPERATION DIRECTOR
Credential: MD
Phone: 301-458-9688