Organization
AXIS SUPPORT SERVICES
Active
Other names
Axis Support Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OLABODE G LONGE CISA, CA (CHIEF EXECUTIVE OFFICER)
(109) 298-4494
Entity
Organization
Contact information
Practice address
9721 LUGUNA RD, MIDDLE RIVER, MD 21220-3769
(443) 226-3289
Mailing address
9721 LUGUNA RD, MIDDLE RIVER, MD 21220-3769
(443) 226-3289
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/07/2020
Last updated
02/07/2020
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