Provider Demographics
NPI:1992327068
Name:EMROS BEHAVIORAL HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:EMROS BEHAVIORAL HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITONER
Authorized Official - Prefix:
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:KWABLA
Authorized Official - Last Name:FIASORGBOR
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:443-655-9931
Mailing Address - Street 1:700 HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2515
Mailing Address - Country:US
Mailing Address - Phone:443-655-9931
Mailing Address - Fax:410-638-1912
Practice Address - Street 1:700 HENDERSON RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2515
Practice Address - Country:US
Practice Address - Phone:443-655-9931
Practice Address - Fax:410-638-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD791275Medicaid