Provider Demographics
NPI:1881385508
Name:MAGSUN MENTAL WELLNESS, INC
Entity type:Organization
Organization Name:MAGSUN MENTAL WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMOTALE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEBAYO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:410-908-9242
Mailing Address - Street 1:1900 E NORTHERN PKWY STE 305
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2111
Mailing Address - Country:US
Mailing Address - Phone:410-908-9242
Mailing Address - Fax:
Practice Address - Street 1:1900 E NORTHERN PKWY STE 305
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2111
Practice Address - Country:US
Practice Address - Phone:410-908-9242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)