Provider Demographics
NPI:1528826690
Name:ESOWOH HEALTHCARE
Entity type:Organization
Organization Name:ESOWOH HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOFANAH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BSN, RN
Authorized Official - Phone:202-304-0633
Mailing Address - Street 1:2115 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5760
Mailing Address - Country:US
Mailing Address - Phone:202-304-0633
Mailing Address - Fax:443-449-5651
Practice Address - Street 1:2115 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5760
Practice Address - Country:US
Practice Address - Phone:443-869-4829
Practice Address - Fax:443-449-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health