Provider Demographics
NPI:1891369013
Name:NATIONAL PIKE HEALTH CENTER, INC.
Entity type:Organization
Organization Name:NATIONAL PIKE HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MOPELOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWOYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-744-8100
Mailing Address - Street 1:5411 OLD FREDERICK RD STE 13
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-2126
Mailing Address - Country:US
Mailing Address - Phone:410-744-8100
Mailing Address - Fax:
Practice Address - Street 1:1201 W PRATT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2674
Practice Address - Country:US
Practice Address - Phone:443-449-5975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL PIKE HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD210511014OtherMD BEHAVIORAL HEALTH ADMINISTRATION