Provider Demographics
NPI:1346740065
Name:COMMUNITY INTERVENTION HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:COMMUNITY INTERVENTION HEALTHCARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADELEKE
Authorized Official - Middle Name:
Authorized Official - Last Name:IBIRONKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-929-3667
Mailing Address - Street 1:12 CLEMATIS CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5032
Mailing Address - Country:US
Mailing Address - Phone:443-929-3667
Mailing Address - Fax:
Practice Address - Street 1:302 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5312
Practice Address - Country:US
Practice Address - Phone:443-929-3667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YA0400X, 101YM0800X, 103TA0400X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty