Provider Demographics
NPI:1518447838
Name:ASPEN WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:ASPEN WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MCTAGGART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-697-4696
Mailing Address - Street 1:146 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-6632
Mailing Address - Country:US
Mailing Address - Phone:301-697-4696
Mailing Address - Fax:
Practice Address - Street 1:519 N MECHANIC ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2133
Practice Address - Country:US
Practice Address - Phone:301-697-4696
Practice Address - Fax:240-362-7516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPEN WELLNESS CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-16
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty