NPIMap

Organization Active NPI

Divine Health Psychiatric Services LLC

  • Multi-Specialty Clinic/Center
  • Reisterstown, MD
National Provider Identifier
1447930706
Registry record updated Jul 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
DIVINE HEALTH PSYCHIATRIC SERVICES LLC
Practice address
117 E Cherry Hill Rd
Reisterstown, MD 21136-3023
Phone
(443) 204-3919
Fax
(410) 521-3671
NPI assigned
Jul 21, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2023

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

Authorized official

Name
Emmanuel GbalaNPI 1245862648
Title
President
Phone
(443) 204-3919

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

117 E Cherry Hill Rd
Reisterstown, MD 21136-3023

Mailing address

117 E Cherry Hill Rd
Reisterstown, MD 21136-3023
Phone (443) 204-3919

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1689897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689897600000",
    "number": "1447930706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 E CHERRY HILL RD",
            "city": "REISTERSTOWN",
            "state": "MD",
            "postal_code": "211363023",
            "telephone_number": "443-204-3919",
            "fax_number": "410-521-3671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 E CHERRY HILL RD",
            "city": "REISTERSTOWN",
            "state": "MD",
            "postal_code": "211363023",
            "telephone_number": "443-204-3919",
            "fax_number": "410-521-3671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE HEALTH PSYCHIATRIC SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-21",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A",
        "authorized_official_last_name": "GBALA",
        "authorized_official_first_name": "EMMANUEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "443-204-3919"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reisterstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2023; 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.