Provider Demographics
NPI:1962040626
Name:MINDFUL HEALING WORKS WELLNESS CENTER
Entity Type:Organization
Organization Name:MINDFUL HEALING WORKS WELLNESS CENTER
Other - Org Name:OMHC
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIAL CONTACT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-631-2723
Mailing Address - Street 1:750 CONCOURSE CIR STE 103-203
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2995
Mailing Address - Country:US
Mailing Address - Phone:443-530-6921
Mailing Address - Fax:443-530-6996
Practice Address - Street 1:1576 MERRITT BLVD STE 8
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-2114
Practice Address - Country:US
Practice Address - Phone:443-530-6533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINDFUL HEALING WORKS WELLNESS CENTER OMHC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-12
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD985059Medicaid