Provider Demographics
NPI:1487308565
Name:EXCELLENT HEALTHCARE & PSYCHIATRIC REHABILITATION PROGRAM SERVICES INC
Entity type:Organization
Organization Name:EXCELLENT HEALTHCARE & PSYCHIATRIC REHABILITATION PROGRAM SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:INNOCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:AKPUAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-984-7411
Mailing Address - Street 1:PO BOX 31699
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-8699
Mailing Address - Country:US
Mailing Address - Phone:410-984-7411
Mailing Address - Fax:
Practice Address - Street 1:4000 - 4002 UNIT A W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5502
Practice Address - Country:US
Practice Address - Phone:410-304-6544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children