1598349789 NPI number — CONFIDENT BODIES & WHOLENESS

Table of content: (NPI 1598349789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598349789 NPI number — CONFIDENT BODIES & WHOLENESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONFIDENT BODIES & WHOLENESS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598349789
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2127 LORRAINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GWYNN OAK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21207-5909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-419-4754
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5248 REISTERSTOWN RD APT 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21215-5083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
672-052-0856
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HART
Authorized Official First Name:
AFRIKUS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-419-4754

Provider Taxonomy Codes

  • Taxonomy code: 174200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QI0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)