1619470218 NPI number — CARE 1ST WELLNESS, LLC

Table of content: (NPI 1619470218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619470218 NPI number — CARE 1ST WELLNESS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE 1ST WELLNESS, LLC
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:
6
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:
1619470218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13180-F GARRETT HIGHWAY, PMB 46
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71 MITCHELL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-616-5707
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/10/2018

Additional Information

Authorized Official

Authorized Official Last Name:
FRIEND
Authorized Official First Name:
MELITA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
301-616-5707

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WG0000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0807X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 221700000X , with the licence number: AT121 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: WVTPID007976 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 980333 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y7983 . This is a "THE HEALTH PLAN OF WEST VIRGINIA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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