# EMMANUEL HEALTH CARE CENTER L.L.LC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851974885
- **Authorized official:** MRS. ADEBOLA TOYOSI ADERETI (CEO)
- **Authorized official phone:** (240) 603-0890

## Contact information

- **Practice address:** 9633 LIBERTY RD STE D, RANDALLSTOWN, MD 21133-2435
- **Practice address phone:** (240) 603-0890
- **Practice address fax:** (443) 272-6766
- **Mailing address:** 9633 LIBERTY RD STE D, RANDALLSTOWN, MD 21133-2435
- **Mailing address phone:** (240) 603-0890
- **Mailing address fax:** (443) 272-6766

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 04/28/2021
- **Last updated:** 04/28/2021