MEDICARE: MENTABILITY HEALTH, LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1750082137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTABILITY HEALTH, LLC

Provider Business Mailing Address
First Line	:	4602 IMPERIAL OAKS LN
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3761
Country	:	US
Telephone Number	:	301-818-1611
Fax Number	:

Provider Business Practice Location Address
First Line	:	4602 IMPERIAL OAKS LN
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3761
Country	:	US
Telephone Number	:	301-818-1611
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. VINSON T FLOURNOY-YOUNG
Credential	:	PRP PROGRAM
Telephone Number	:	301-818-1611

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	03/13/2023

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