Provider Demographics
NPI:1376073643
Name:ALLWELL HEALTHCARE SOLUTION
Entity Type:Organization
Organization Name:ALLWELL HEALTHCARE SOLUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-755-5124
Mailing Address - Street 1:7365 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-9456
Mailing Address - Country:US
Mailing Address - Phone:443-755-5124
Mailing Address - Fax:240-554-2345
Practice Address - Street 1:7365 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:MD
Practice Address - Zip Code:20794-9456
Practice Address - Country:US
Practice Address - Phone:443-755-5124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR4010251J00000X
363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5900042900Medicaid