Healthcare Provider Details

I. General information

NPI: 1831859990
Provider Name (Legal Business Name): COMMUNITY INTERVENTION HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 REISTERSTOWN RD
PIKESVILLE MD
21208-5312
US

IV. Provider business mailing address

302 REISTERSTOWN RD
PIKESVILLE MD
21208-5312
US

V. Phone/Fax

Practice location:
  • Phone: 410-929-3667
  • Fax:
Mailing address:
  • Phone: 443-929-3667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADELEKE IBIRONKE
Title or Position: CEO / OWNER
Credential:
Phone: 443-929-3667