Healthcare Provider Details

I. General information

NPI: 1497384705
Provider Name (Legal Business Name): TEMAH HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 OLD COURT RD STE 304
RANDALLSTOWN MD
21133-6202
US

IV. Provider business mailing address

4320 BROOKSIDE OAKS
OWINGS MILLS MD
21117-5169
US

V. Phone/Fax

Practice location:
  • Phone: 410-521-8000
  • Fax: 410-655-5826
Mailing address:
  • Phone: 410-521-8000
  • Fax: 410-655-5826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name: TEMITOPE S WILLIAMS
Title or Position: PSYCHIATRIC MENTAL HEALTH NURSE PRA
Credential: CRNP, PMH-BC
Phone: 410-521-8000