Provider Demographics
NPI:1225681810
Name:THE ELYSIAN FIELDS OPTIMUM WELLNESS AND MENTAL HEALTH GROUP, LLC
Entity Type:Organization
Organization Name:THE ELYSIAN FIELDS OPTIMUM WELLNESS AND MENTAL HEALTH GROUP, LLC
Other - Org Name:THE SEVENTY TIMES SEVEN WELLNESS MISSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:410-367-0708
Mailing Address - Street 1:2222 N HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5609
Mailing Address - Country:US
Mailing Address - Phone:410-624-5037
Mailing Address - Fax:
Practice Address - Street 1:4241 SHELDON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-6404
Practice Address - Country:US
Practice Address - Phone:410-624-5037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LYSIAN FIELDS OPTIMUM WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-22
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility