NPIMap

Organization Active NPI

Victorious Mental Healthcare LLC

  • Community/Behavioral Health Agency
  • Baltimore, MD
National Provider Identifier
1962032995
Registry record updated Jan 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 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
Last updated
Jan 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2020

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

Authorized official

Name
Bosede Oluwatoyin Adetunji - Idowu
Title
Ceo
Phone
(443) 540-0338

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

5006 Belair Rd
Baltimore, MD 21206-5101

Mailing address

5006 Belair Rd
Baltimore, MD 21206-5101
Phone (443) 540-0338

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Victorious Mental Healthcare LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 8

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": "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

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2020; 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.