Provider Demographics
NPI:1952284044
Name:BALM OF GILEAD HEALTH & WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:BALM OF GILEAD HEALTH & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHINWE
Authorized Official - Middle Name:M
Authorized Official - Last Name:OKUDO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:443-868-7405
Mailing Address - Street 1:5440 BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-4208
Mailing Address - Country:US
Mailing Address - Phone:443-868-7405
Mailing Address - Fax:
Practice Address - Street 1:5440 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-4208
Practice Address - Country:US
Practice Address - Phone:443-868-7405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty