NPIMap

Organization Active NPI

Gebaj Mental Health and Core Services Clinic, Inc

  • Psychiatric/Mental Health Registered Nurse
  • Riverdale, MD
National Provider Identifier
1922866011
Registry record updated Sep 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X
Legal business name
GEBAJ MENTAL HEALTH AND CORE SERVICES CLINIC, INC
Doing business as
Gebaj Mental Health and Core Services Clinic, Inc
Practice address
6200 Baltimore Ave
#300-R9
Riverdale, MD 20737-1054
Phone
(240) 930-0811
Fax
(443) 272-7756
NPI assigned
Mar 12, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2025

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

Authorized official

Name
Basil E. Fomanka, PMHNPNPI 1013621010
Title
Ceo/Owner
Phone
(443) 520-8138

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WP0808X Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

6200 Baltimore Ave
#300-R9
Riverdale, MD 20737-1054

Mailing address

6200 Baltimore Ave
300-R9
Riverdale, MD 20737-1054
Phone (240) 930-0811

Other names 1

  • GEBAJ MENTAL HEALTH AND CORE SERVICES CLINIC, INC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240809003997 DC Part B Supplier - Clinic/Group Practice 5294273140 Receives reassigned benefits from 1 practitioner
Practice locations: Riverdale, MD

National Provider Directory

National Provider Directory

Locations

6200 Baltimore Ave
#300R9
Riverdale, MD 20737
Phone (240) 930-0811

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1710201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758153600000",
    "number": "1922866011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 BALTIMORE AVE",
            "address_2": "300-R9",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371054",
            "telephone_number": "240-930-0811",
            "fax_number": "443-272-7756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 BALTIMORE AVE",
            "address_2": "#300-R9",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371054",
            "telephone_number": "240-930-0811",
            "fax_number": "443-272-7756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEBAJ MENTAL HEALTH AND CORE SERVICES CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-12",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A",
        "authorized_official_last_name": "FOMANKA",
        "authorized_official_first_name": "BASIL",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "443-520-8138",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GEBAJ MENTAL HEALTH AND CORE SERVICES CLINIC, INC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GEBAJ MENTAL HEALTH AND CORE SERVICES CLINIC, INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverdale, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.