Provider Demographics
NPI:1376180398
Name:MAZWI HOLISTIC INSTITUTE INC
Entity Type:Organization
Organization Name:MAZWI HOLISTIC INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-282-8949
Mailing Address - Street 1:1 CONTINENTAL CT APT 302
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5370
Mailing Address - Country:US
Mailing Address - Phone:443-282-8949
Mailing Address - Fax:
Practice Address - Street 1:1705 W FAYETTE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-1708
Practice Address - Country:US
Practice Address - Phone:443-282-8949
Practice Address - Fax:410-947-5306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health