Healthcare Provider Details

I. General information

NPI: 1902409725
Provider Name (Legal Business Name): EROSUN BEHAVIORAL HEALTH SERVICES INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10811 RED RUN BLVD STE 110
OWINGS MILLS MD
21117-5150
US

IV. Provider business mailing address

10811 RED RUN BLVD STE 204
OWINGS MILLS MD
21117-5151
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-4641
  • Fax:
Mailing address:
  • Phone: 410-296-4641
  • Fax: 410-296-4643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SEGUN OLADUNNI
Title or Position: CEO
Credential: MA
Phone: 410-296-4641