Provider Demographics
NPI:1417783358
Name:MARYLAND HEALTH FOUNDATION LLC
Entity type:Organization
Organization Name:MARYLAND HEALTH FOUNDATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULRAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-761-9169
Mailing Address - Street 1:6910 HOLABIRD AVE
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-1788
Mailing Address - Country:US
Mailing Address - Phone:443-761-9169
Mailing Address - Fax:
Practice Address - Street 1:6910 HOLABIRD AVE
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-1788
Practice Address - Country:US
Practice Address - Phone:443-761-9169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder