Provider Demographics
NPI:1316472061
Name:BK BEHAVIORIAL HEALTH CENTER
Entity type:Organization
Organization Name:BK BEHAVIORIAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-991-0360
Mailing Address - Street 1:14300 CHERRY LANE CT STE 202-203
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4958
Mailing Address - Country:US
Mailing Address - Phone:240-360-2637
Mailing Address - Fax:240-360-2647
Practice Address - Street 1:9332 ANNAPOLIS RD
Practice Address - Street 2:SUITE 312
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3113
Practice Address - Country:US
Practice Address - Phone:571-991-0360
Practice Address - Fax:866-707-8571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0000000Medicaid