Provider Demographics
NPI:1417409160
Name:BORNFREE WELLNESS CENTERS OF AMERICA
Entity Type:Organization
Organization Name:BORNFREE WELLNESS CENTERS OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SPONSOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GALAHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-991-5687
Mailing Address - Street 1:19537 DOCTORS DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-5262
Mailing Address - Country:US
Mailing Address - Phone:240-654-4001
Mailing Address - Fax:240-654-4190
Practice Address - Street 1:19537 DOCTOR'S DRIVE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874
Practice Address - Country:US
Practice Address - Phone:301-453-5111
Practice Address - Fax:703-880-6378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1417409160Medicaid