Mattdivine Healthcare and Wellness Services LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

MATTDIVINE HEALTHCARE AND WELLNESS SERVICES LLC

Practice address

8506 Snowden Loop
Laurel, MD 20708-2360

Phone

(240) 501-0232

NPI assigned

Jul 15, 2022

Organization subpart

No

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

Authorized official

Name

Ogochukwu Enyi, PMHNPNPI 1194068866

Title

Ceo

Phone

(240) 501-0232

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ogochukwu Enyi, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Laurel, MD
  • NPI 1194068866

  DC

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1657843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657843200000",
    "number": "1902530702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8506 SNOWDEN LOOP",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207082360",
            "telephone_number": "240-501-0232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8506 SNOWDEN LOOP",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207082360",
            "telephone_number": "240-501-0232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTDIVINE HEALTHCARE AND WELLNESS SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-15",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A",
        "authorized_official_last_name": "ENYI",
        "authorized_official_first_name": "OGOCHUKWU",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "240-501-0232",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Laurel, MD
• Providers in Laurel, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.