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General NPI Number Information
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NPI Number | 1174319495
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Entity Type | Organization
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Legal Business Name | IMMACULATE BEHAVIORAL HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 2255 CRAIN HWY STE 205
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City | WALDORF
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State | MD
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Zip | 20601-3190
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Country | US
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Telephone | 301-377-4325
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Fax |
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Provider Business Mailing Address
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Address Line | 10612 CHERYL TURN
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City | WALDORF
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State | MD
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Zip | 20603-6914
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Country | US
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Telephone | 301-377-4325
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Fax |
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Authorized Official
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Title or Position | OWNER OF ENTITY
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Name | OLUWATOYIN R ADELAKUN
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Credential |
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Telephone | 301-377-4325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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