Provider Demographics
NPI:1154815454
Name:COMPASSIONATE WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:COMPASSIONATE WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:N
Authorized Official - Last Name:ZAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-502-1535
Mailing Address - Street 1:10319 WESTLAKE DR STE 193
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6403
Mailing Address - Country:US
Mailing Address - Phone:240-513-6001
Mailing Address - Fax:240-513-6122
Practice Address - Street 1:44 N POTOMAC ST STE 101
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-3301
Practice Address - Country:US
Practice Address - Phone:240-513-6001
Practice Address - Fax:240-513-6122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPASSIONATE WELLNESS CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-20
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD986006100Medicaid