NPIMap

Organization Active NPI

Optimum Wellness Center LLC.

  • Community/Behavioral Health Agency
  • Baltimore, MD
National Provider Identifier
1154081909
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
OPTIMUM WELLNESS CENTER LLC.
Practice address
3455 Wilkens Ave Ste 301
Baltimore, MD 21229-5214
Phone
(410) 627-3386
Fax
(410) 646-0747
NPI assigned
Dec 21, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Authorized official

Name
Mr. Darryl Xavier Whitehead
Title
Ceo
Phone
(410) 627-3386

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

3455 Wilkens Ave Ste 301
Baltimore, MD 21229-5214

Mailing address

3455 Wilkens Ave Ste 301
Baltimore, MD 21229-5214
Phone (410) 627-3386

National Provider Directory

National Provider Directory
Tax ID family
Optimum Wellness Center LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1640044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640044800000",
    "number": "1154081909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3455 WILKENS AVE STE 301",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212295214",
            "telephone_number": "410-627-3386",
            "fax_number": "410-646-0747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 WILKENS AVE STE 301",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212295214",
            "telephone_number": "410-627-3386",
            "fax_number": "410-646-0747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMUM WELLNESS CENTER LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-21",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-15",
        "status": "A",
        "authorized_official_last_name": "WHITEHEAD",
        "authorized_official_first_name": "DARRYL",
        "authorized_official_middle_name": "XAVIER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "410-627-3386",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; 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.