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Organization
EMMANUEL HEALTH CARE CENTER L.L.LC.
Active
Organization
EMMANUEL HEALTH CARE CENTER L.L.LC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ADEBOLA TOYOSI ADERETI (CEO)
(240) 603-0890
Entity
Organization
Contact information
Practice address
9633 LIBERTY RD STE D, RANDALLSTOWN, MD 21133-2435
(240) 603-0890
(443) 272-6766
Mailing address
9633 LIBERTY RD STE D, RANDALLSTOWN, MD 21133-2435
(240) 603-0890
(443) 272-6766
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
NULL
163W00000X
Registered Nurse
—
—
164W00000X
Licensed Practical Nurse
—
NULL
164W00000X
Licensed Practical Nurse
—
—
261QP2300X
Primary Care Clinic/Center
—
NULL
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
04/28/2021
Last updated
04/28/2021
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