Victorious Mental Healthcare LLC
Organization Active NPI Community/Behavioral Health Agency · Baltimore, MD
NPI 1962032995 · NPPES record last updated Jan 17, 2020
Key facts
- NPI
- 1962032995
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- VICTORIOUS MENTAL HEALTHCARE LLC
- Practice address
- 5006 Belair Rd
Baltimore, MD 21206-5101 - Phone
- (443) 540-0338
- NPI assigned
- Jan 17, 2020
- Organization subpart
- No
Authorized official
- Name
- Bosede Oluwatoyin Adetunji - Idowu
- Title
- Ceo
- Phone
- (443) 540-0338
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 2
Practitioners 8
-
Abena Adoko Sando, MSW, LCSW-C
-
Erica E Johnson, LCSW-C
-
Kehinde Deborah Joseph, PMHNP-BC
-
Bridgette Lori Threat, LCSW-C
-
Ruphina Ogechi Nnebedum, PMHNP-BC
-
Charles Dankwa Sarbeng, DNP, FNP-BC, PHMNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200707002307 | MD | Part B Supplier - Clinic/Group Practice | 7719300946 |
Receives reassigned benefits from 5 practitioners 1 other NPI on this enrollment Practice locations: Baltimore, MD |
National Provider Directory
- Tax ID family
- Victorious Mental Healthcare LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
5006 Belair Rd
Baltimore, MD 21206-5101
Mailing address
5006 Belair Rd
Baltimore, MD 21206-5101
Phone (443) 540-0338
NPI Registry JSON
{
"created_epoch": "1579219200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1579219200000",
"number": "1962032995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5006 BELAIR RD",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212065101",
"telephone_number": "443-540-0338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5006 BELAIR RD",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212065101",
"telephone_number": "443-540-0338"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VICTORIOUS MENTAL HEALTHCARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-01-17",
"last_updated": "2020-01-17",
"certification_date": "2020-01-17",
"status": "A",
"authorized_official_last_name": "ADETUNJI - IDOWU",
"authorized_official_first_name": "BOSEDE",
"authorized_official_middle_name": "OLUWATOYIN",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "443-540-0338"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
- Victoria'S Place
- Amanda Klink Victorino
- Victorious Mental Healthcare LLC
- Victorious Mental Healthcare LLC
- Victorious Mental Healthcare LLC
- Lane Alan Victorson
- Victory Behavioral Solutions LLC
- Victory Behavioral Solutions LLC
- Victory Behavioral Solutions LLC
- Victory Behavioral Solutions LLC
All providers in Baltimore, MD · Community/Behavioral Health Agency in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.