Healthcare Provider Details

I. General information

NPI: 1194446450
Provider Name (Legal Business Name): ENFIELD LOCKE CARE RESOURCES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 FREDERICK RD STE 158
CATONSVILLE MD
21228-4633
US

IV. Provider business mailing address

405 FREDERICK RD STE 158
CATONSVILLE MD
21228-4633
US

V. Phone/Fax

Practice location:
  • Phone: 667-407-2550
  • Fax: 443-327-4613
Mailing address:
  • Phone: 667-407-2550
  • Fax: 443-327-4613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TEMIDAYO A OGUNDIRAN
Title or Position: CEO
Credential:
Phone: 443-558-6938