Healthcare Provider Details

I. General information

NPI: 1578432506
Provider Name (Legal Business Name): AWAKEN HEALTH GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8406 DOWNEY DALE DR
RANDALLSTOWN MD
21133-4815
US

IV. Provider business mailing address

8406 DOWNEY DALE DR
RANDALLSTOWN MD
21133-4815
US

V. Phone/Fax

Practice location:
  • Phone: 443-495-3223
  • Fax:
Mailing address:
  • Phone: 443-495-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHIDIMMA DAISY UCHE
Title or Position: CEO
Credential: LPN, CGRC
Phone: 443-514-5145