Healthcare Provider Details

I. General information

NPI: 1841048766
Provider Name (Legal Business Name): TEMAH HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SCOTT ADAM RD STE 204
COCKEYSVILLE MD
21030-3295
US

IV. Provider business mailing address

4320 BROOKSIDE OAKS
OWINGS MILLS MD
21117-5169
US

V. Phone/Fax

Practice location:
  • Phone: 410-521-8000
  • Fax: 410-655-5826
Mailing address:
  • Phone: 410-521-8000
  • Fax: 410-655-5826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: GBENGA WILLIAMS
Title or Position: ADMINISTRATOR
Credential:
Phone: 410-521-8000