Healthcare Provider Details

I. General information

NPI: 1508881384
Provider Name (Legal Business Name): NATIONAL PIKE HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 SHIPPING PL
DUNDALK MD
21222-4318
US

IV. Provider business mailing address

23 SHIPPING PL
DUNDALK MD
21222-4318
US

V. Phone/Fax

Practice location:
  • Phone: 410-282-5401
  • Fax:
Mailing address:
  • Phone: 410-282-5401
  • Fax: 410-282-5403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10041, 10075
License Number StateMD

VIII. Authorized Official

Name: MR. JOHNSON OLUDARE OWOYEMI
Title or Position: PRESIDENT
Credential: MS
Phone: 410-744-8100