Healthcare Provider Details

I. General information

NPI: 1801692579
Provider Name (Legal Business Name): MGM HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8005 UPPERFIELD CT
OWINGS MILLS MD
21117-5579
US

IV. Provider business mailing address

8005 UPPERFIELD CT
OWINGS MILLS MD
21117-5579
US

V. Phone/Fax

Practice location:
  • Phone: 443-500-9190
  • Fax:
Mailing address:
  • Phone: 443-500-9190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MARY GORETY OYIRO
Title or Position: CEO
Credential:
Phone: 443-500-9190