Healthcare Provider Details

I. General information

NPI: 1871466151
Provider Name (Legal Business Name): INNOVATION HEALTH SYSTEM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2138 ESPEY CT STE 1
CROFTON MD
21114-2495
US

IV. Provider business mailing address

2138 ESPEY CT STE 1
CROFTON MD
21114-2495
US

V. Phone/Fax

Practice location:
  • Phone: 443-470-7916
  • Fax: 443-470-7718
Mailing address:
  • Phone: 443-470-7916
  • Fax: 443-470-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: RICHARD ASAH NKWETTA
Title or Position: CEO/DIRECTOR
Credential: MSN, APRN, PMHNP-BC,
Phone: 240-645-8864