NPIMap

Organization Active NPI

Maryland Wellness LLC

  • Substance Abuse Rehabilitation Facility
  • Waldorf, MD
National Provider Identifier
1013622273
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
MARYLAND WELLNESS LLC
Practice address
2255 Crain Hwy Ste 106
Waldorf, MD 20601-3186
Phone
(410) 314-1030
Fax
(410) 314-1030
NPI assigned
Jan 20, 2023
Last updated
Apr 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sierra Burley
Title
Credentialing Specialist
Phone
(410) 314-1030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

2255 Crain Hwy Ste 106
Waldorf, MD 20601-3186

Mailing address

4128 Hayward Ave # W
Baltimore, MD 21215-4340
Phone (410) 314-1030

Other practice location 1

4128 Hayward Ave
Baltimore, MD 21215-4340
Phone (410) 314-1030

Other identifiers 2

IdentifierTypeStateIssuer
220412456OtherMDMD DEPARTMENT OF HEALTH - LEVEL 2.1 - INTENSIVE OUTPATIENT TREATMENT PROGRAM
220412455OtherMDMD DEPARTMENT OF HEALTH - LEVEL 1 - OUTPATIENT TREATMENT PROGRAM

National Provider Directory

National Provider Directory
Tax ID family
Maryland Wellness LLC39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744761600000",
    "number": "1013622273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4128 HAYWARD AVE # W",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212154340",
            "telephone_number": "410-314-1030",
            "fax_number": "410-314-1030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 CRAIN HWY STE 106",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206013186",
            "telephone_number": "410-314-1030",
            "fax_number": "410-314-1030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4128 Hayward Ave",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212154340",
            "country_code": "US",
            "telephone_number": "410-314-1030",
            "fax_number": "410-314-1030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MARYLAND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-20",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A",
        "authorized_official_last_name": "BURLEY",
        "authorized_official_first_name": "SIERRA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "410-314-1030"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD DEPARTMENT OF HEALTH - LEVEL 2.1 - INTENSIVE OUTPATIENT TREATMENT PROGRAM",
            "identifier": "220412456",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD DEPARTMENT OF HEALTH - LEVEL 1 - OUTPATIENT TREATMENT PROGRAM",
            "identifier": "220412455",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.