Provider Demographics
NPI:1689383390
Name:BLUE SPRING WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:BLUE SPRING WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOTENESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NJOROGE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:106-468-1674
Mailing Address - Street 1:807 E BALTIMORE ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-5388
Mailing Address - Country:US
Mailing Address - Phone:410-646-8167
Mailing Address - Fax:
Practice Address - Street 1:807 E BALTIMORE ST STE 1A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-5388
Practice Address - Country:US
Practice Address - Phone:410-646-8167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE SPRING WELLNESS CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder