Provider Demographics
NPI:1740747625
Name:NANOR WELLNESS VILLAGE LLC
Entity Type:Organization
Organization Name:NANOR WELLNESS VILLAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NANOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-200-3849
Mailing Address - Street 1:2919 OLNEY SANDY SPRING RD STE A
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1587
Mailing Address - Country:US
Mailing Address - Phone:301-200-3849
Mailing Address - Fax:
Practice Address - Street 1:2919 OLNEY SANDY SPRING RD STE A
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1587
Practice Address - Country:US
Practice Address - Phone:301-200-3849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health