Healthcare Provider Details

I. General information

NPI: 1316472061
Provider Name (Legal Business Name): BK BEHAVIORIAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9332 ANNAPOLIS RD SUITE 312
LANHAM MD
20706-3113
US

IV. Provider business mailing address

14300 CHERRY LANE CT STE 202-203
LAUREL MD
20707-4958
US

V. Phone/Fax

Practice location:
  • Phone: 571-991-0360
  • Fax: 866-707-8571
Mailing address:
  • Phone: 240-360-2637
  • Fax: 240-360-2647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BERNADETTE S KAMARA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 571-991-0360