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General NPI Number Information
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NPI Number | 1275930711
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Entity Type | Organization
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Legal Business Name | KAYGEE40, INCORPORATION
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Dates
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Enumeration Date | 11/28/2014
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Last Update Date | 11/28/2014
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Provider Practice Location Address
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Address Line | 6911 LAUREL BOWIE RD SUITE #303
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City | BOWIE
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State | MD
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Zip | 20715-1712
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Country | US
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Telephone | 301-704-5094
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Fax |
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Provider Business Mailing Address
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Address Line | 6911 LAUREL BOWIE RD SUITE #303
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City | BOWIE
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State | MD
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Zip | 20715-1712
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Country | US
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Telephone | 301-704-5094
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Fax |
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Authorized Official
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Title or Position | PROGRAM ADMINISTRATOR
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Name | MR. OLUKAYODE TOPE TAIWO
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Credential | RN, MSN, MBA
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Telephone | 301-704-5094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | MH-1511
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MH-1511
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License Number State | MD
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