Organization
MALAMA MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMELA J FERGUSON CNP (OWNER/ NURSE PRACTITIONER)
(443) 802-5130
Entity
Organization
Contact information
Practice address
4604 YORK RD, BALTIMORE, MD 21212-4726
(443) 802-5130
Mailing address
4604 YORK RD, BALTIMORE, MD 21212-4726
(443) 902-8017
(443) 201-7037
Taxonomy
Speciality
Code
Description
License number
State
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
Primary
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
11/29/2021
Last updated
03/06/2023
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