Healthcare Provider Details

I. General information

NPI: 1215712104
Provider Name (Legal Business Name): JAY CARE MENTAL HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/29/2023
Certification Date: 08/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8508 LOCH RAVEN BLVD STE E
TOWSON MD
21286-2354
US

IV. Provider business mailing address

8508 LOCH RAVEN BLVD STE E
TOWSON MD
21286-2354
US

V. Phone/Fax

Practice location:
  • Phone: 443-275-2354
  • Fax: 410-853-7263
Mailing address:
  • Phone: 443-275-2354
  • Fax: 410-853-7263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. CHINYERE MABLE OBI
Title or Position: CEO/MEDICAL DIRECTOR
Credential:
Phone: 443-985-4976