TARGET BEHAVIORAL HEALTH SERVICES, LLC (NPI# 1235749771) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235749771 |
| Entity Type | Organization |
| Organization Name | TARGET BEHAVIORAL HEALTH SERVICES, LLC |
| Other Organization Name | TARGET BEHAVIORAL HEALTH SERVICES, LLC |
| Practice Address |
1415 Moonshadow Rd Bel Air MD 21015-4999 |
| Practice Telephone | 4109008897 |
| Mailing Telephone | 4109008897 |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2020-09-21 |
| Authorized Official Name | DR. FOLASHADE KANIMODO (CEO) |
| Authorized Official Telephone | 4109008897 |
| Authorized Official Credential | CRNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Target Behavioral Health Services, LLC | Other Name - Individual/Organization |
| Street Address |
1415 MOONSHADOW RD |
| City | BEL AIR |
| State | MD |
| Zip Code | 21015-4999 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760609176 | Olusegun A Adediran | Pharmacist | 1415 Moonshadow Rd, Bel Air, MD 21015-4999 | 2007-04-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114525235 | Graceful Speech-language Therapy | Speech-Language Pathologist | 610 Mauser Dr, Bel Air, MD 21015 | 2020-10-12 |
| 1770124844 | Asana Medical Supplies LLC | Durable Medical Equipment & Medical Supplies | 815 Sapling Ct, Bel Air, MD 21015 | 2019-09-30 |
| 1427601103 | Newpoints | Substance Abuse Rehabilitation Facility | 242 Ogden Court, Bel Air, MD 21015 | 2019-07-22 |
| 1184186199 | Notable Life Counseling Services LLC | Counselor | 2107-2109 Laurel Bush Road, Ste 103b, Bel Air, MD 21015 | 2019-04-01 |
| 1295293553 | Gary Reznik D.d.s., P.a. | Dentist | 1816 Emmorton Rd, Bel Air, MD 21015 | 2019-03-06 |
| 1942770524 | Erin Tromblay | Speech-Language Pathologist | 85 Patterson Mill Road, Bel Air, MD 21015 | 2018-11-27 |
| 1740638857 | Holly A Smith | Nurse Practitioner | 5 Bel Air Parkway, Suite 1535, Bel Air, MD 21015 | 2016-05-31 |
| 1891155420 | National Rehabilitation Hospital, Inc | Clinic/Center | 12 Medstar Boulevard, Suite 325, Bel Air, MD 21015 | 2016-02-24 |
| 1780002956 | Louis Rosson Robinett IIi | Internal Medicine | 2227 Old Emmorton Rd Ste 120, Bel Air, MD 21015 | 2014-04-03 |
| 1609207083 | Vicki Lynn Goldberg | Physical Therapist | 2304 Churchville Road, Bel Air, MD 21015 | 2013-12-10 |
| Find all providers in zip 21015 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689207607 | Harford Health and Wellness | Nurse Practitioner | 4 North Ave Ste 420, Bel Air, MD 21014-2314 | 2020-02-18 |
| 1003456617 | Alison Ann Mclaughlin | Nurse Practitioner | 4 North Ave # 420, Bel Air, MD 21014-2314 | 2020-01-11 |
| 1902093925 | Nadia M Swanson | Nurse Practitioner | 260 Gateway Dr., Suite 16c, Bel Air, MD 21014-4285 | 2007-10-03 |
| 1265039549 | Wellness Legacy LLC | Nurse Practitioner | 260 Gateway Dr Ste 13, Bel Air, MD 21014-4268 | 2020-10-08 |
| 1992317846 | Nakeia Newton | Nurse Practitioner | 2012 S Tollgate Rd Ste 205, Bel Air, MD 21015-5902 | 2020-08-21 |
| 1659981264 | Samantha Jones | Nurse Practitioner | 260 Gateway Dr, Bel Air, MD 21014-4268 | 2020-08-07 |
| 1992345714 | Herman Ndungu | Nurse Practitioner | 1030 Rock Spring Rd, Bel Air, MD 21014-2322 | 2020-01-09 |
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| 1992304372 | Catherine Koskei | Nurse Practitioner | 2295 Lowell Ridge Rd Apt B, Parkville, MD 21234-2370 | 2020-10-18 |
| 1194323857 | Meliora Davies | Nurse Practitioner | 206 Settlers Way, Upper Marlboro, MD 20774-5770 | 2020-10-14 |
| 1932707171 | David Mwangi | Nurse Practitioner | 27 Blue Spire Cir, Middle River, MD 21220-1743 | 2020-10-10 |
| 1750989042 | Osereme Nora Agboifo | Nurse Practitioner | 200 Ejoppa Rd Suite 106, Townson, MD 21286 | 2020-10-09 |
| 1639776446 | Serenity Heart Healthcare, LLC | Nurse Practitioner | 6755 Business Pkwy Ste 304, Elkridge, MD 21075-6740 | 2020-10-05 |
| 1689281529 | Premier Psychiatry, LLC | Nurse Practitioner | 10601 Virginia Ave, Cockeysville, MD 21030-2315 | 2020-09-24 |
| 1407462559 | Mem Scepter Home & Behavioral | Nurse Practitioner | 14104 Dawn Whistle Way, Bowie, MD 20721-1304 | 2020-09-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.