NPIMap

Organization Active NPI

Maryland Wellness LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Waldorf, MD
National Provider Identifier
1609572676
Registry record updated Feb 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
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
Feb 1, 2023
Last updated
Feb 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2023

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

Authorized official

Name
Casey Wu
Title
Director
Phone
(214) 659-1503

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

2255 Crain Hwy Ste 106
Waldorf, MD 20601-3186

Mailing address

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

Other practice location 1

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

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": "1675209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675209600000",
    "number": "1609572676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4128 HAYWARD AVE",
            "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": "2023-02-01",
        "last_updated": "2023-02-01",
        "certification_date": "2022-11-14",
        "status": "A",
        "authorized_official_last_name": "WU",
        "authorized_official_first_name": "CASEY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "214-659-1503"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Feb 1, 2023; 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.