Healthcare Provider Details

I. General information

NPI: 1225954019
Provider Name (Legal Business Name): SABAOTH BEHAVIORAL HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3167 PINE ORCHARD LN APT 302
ELLICOTT CITY MD
21042-4203
US

IV. Provider business mailing address

3167 PINE ORCHARD LN APT 302
ELLICOTT CITY MD
21042-4203
US

V. Phone/Fax

Practice location:
  • Phone: 410-680-6791
  • Fax:
Mailing address:
  • Phone: 410-680-6791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EJOBOSELE IKHAJIAGBE
Title or Position: OWNER
Credential:
Phone: 410-680-6791