=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609254556
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISAIAH ASSOCIATES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2015
-----------------------------------------------------
Last Update Date | 03/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 PHILADELPHIA RD
-----------------------------------------------------
City | JOPPA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21085-3198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-618-6779
-----------------------------------------------------
Fax | 410-670-9013
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 PHILADELPHIA RD
-----------------------------------------------------
City | JOPPA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21085-3198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-618-6779
-----------------------------------------------------
Fax | 410-670-9013
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF ADMINISTRATIVE OFFICER
-----------------------------------------------------
Name | EDWIN CHUKU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-618-6779
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------