NPIMap

Organization Active NPI

Victorious Mental Healthcare LLC

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Baltimore, MD
National Provider Identifier
1750036893
Registry record updated Mar 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
Legal business name
VICTORIOUS MENTAL HEALTHCARE LLC
Practice address
2901 Druid Park Dr Ste A202
Baltimore, MD 21215-8131
Phone
(410) 488-5171
Fax
(410) 488-5173
NPI assigned
Feb 17, 2022
Last updated
Mar 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2022

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

Authorized official

Name
Bosede O Adetunji IdowuNPI 1770113250
Title
Owner
Phone
(443) 540-0338

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
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X Primary

Addresses

Primary practice location

2901 Druid Park Dr Ste A202
Baltimore, MD 21215-8131

Mailing address

2901 Druid Park Dr Ste A202
Baltimore, MD 21215-8131
Phone (410) 488-5171

Other names 1

  • VICTORIOUS PRP Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1645056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646265600000",
    "number": "1750036893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 DRUID PARK DR STE A202",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212158131",
            "telephone_number": "410-488-5171",
            "fax_number": "410-488-5173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 DRUID PARK DR STE A202",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212158131",
            "telephone_number": "410-488-5171",
            "fax_number": "410-488-5173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORIOUS MENTAL HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-17",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A",
        "authorized_official_last_name": "ADETUNJI IDOWU",
        "authorized_official_first_name": "BOSEDE",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-540-0338"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VICTORIOUS PRP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2022; 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.