Provider Demographics
NPI:1306597810
Name:WINNERS HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:WINNERS HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUMOKE
Authorized Official - Middle Name:FADEKE
Authorized Official - Last Name:OMISORE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:410-903-9206
Mailing Address - Street 1:1529 WINFIELDS LN
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1127
Mailing Address - Country:US
Mailing Address - Phone:410-790-9640
Mailing Address - Fax:
Practice Address - Street 1:6600 YORK RD STE 112
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2029
Practice Address - Country:US
Practice Address - Phone:410-903-9206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINNERS HEALTHCARE SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD799694200Medicaid