Vidahealth Care Inc

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

VIDAHEALTH CARE INC

Practice address

3410 Kelox Rd
Gwynn Oak, MD 21207-6203

Phone

(443) 627-3104

NPI assigned

Nov 8, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Isaac Fadeyibi, PH.D.

Title

Ceo

Phone

(443) 627-3104

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731024000000",
    "number": "1003630823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3410 KELOX RD",
            "city": "GWYNN OAK",
            "state": "MD",
            "postal_code": "212076203",
            "telephone_number": "443-627-3104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3410 KELOX RD",
            "city": "GWYNN OAK",
            "state": "MD",
            "postal_code": "212076203",
            "telephone_number": "443-627-3104"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18348 Spark Dr Unit 201",
            "address_purpose": "LOCATION",
            "city": "Hagerstown",
            "state": "MD",
            "postal_code": "217402086",
            "country_code": "US",
            "telephone_number": "443-627-3104",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VIDAHEALTH CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-08",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-07",
        "status": "A",
        "authorized_official_last_name": "FADEYIBI",
        "authorized_official_first_name": "ISAAC",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "443-627-3104",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.