Organization
VIDAHEALTH CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ISAAC FADEYIBI PH.D. (CEO)
(443) 627-3104
Entity
Organization
Contact information
Practice address
3410 KELOX RD, GWYNN OAK, MD 21207-6203
(443) 627-3104
Mailing address
3410 KELOX RD, GWYNN OAK, MD 21207-6203
(443) 627-3104
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/08/2024
Last updated
11/08/2024
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