Provider Demographics
NPI:1619603263
Name:ONE HEART HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:ONE HEART HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BLANCHE
Authorized Official - Middle Name:CEFORA
Authorized Official - Last Name:KATTIE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP
Authorized Official - Phone:301-259-3574
Mailing Address - Street 1:10705 CHARTER DR STE 430
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2870
Mailing Address - Country:US
Mailing Address - Phone:301-259-3574
Mailing Address - Fax:301-235-1556
Practice Address - Street 1:10705 CHARTER DR STE 430
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2870
Practice Address - Country:US
Practice Address - Phone:301-259-3574
Practice Address - Fax:301-235-1556
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONE HEART HEALTH AND WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation