MEDICARE: DYNAMIC HEALTH SYSTEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1134722218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	200 TODDSON LN
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-5053
Country	:	US
Telephone Number	:	410-598-2219
Fax Number	:

Provider Business Practice Location Address
First Line	:	2628 GARRETT AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-4834
Country	:	US
Telephone Number	:	410-708-2598
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AHMED OLAYINKA ANIBABA
Credential	:
Telephone Number	:	443-708-2598

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	12/03/2021

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Directions to “DYNAMIC HEALTH SYSTEM ” Practice Location

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