Basic Information
| Provider Information | |||||||||
| NPI: | 1497218317 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IMIND HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4703 OLD SOPER RD STE R1 | ||||||||
| Address2: | |||||||||
| City: | CAMP SPRINGS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207464030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2402490989 | ||||||||
| FaxNumber: | 2402568887 | ||||||||
| Practice Location | |||||||||
| Address1: | 4703 OLD SOPER RD STE R1 | ||||||||
| Address2: | |||||||||
| City: | CAMP SPRINGS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207464030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2402490989 | ||||||||
| FaxNumber: | 2402568887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2019 | ||||||||
| LastUpdateDate: | 04/08/2019 | ||||||||
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| AuthorizedOfficialLastName: | FLYNN | ||||||||
| AuthorizedOfficialFirstName: | KHANH-LINH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2402490989 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 163WA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QR0405X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.