Provider Demographics
NPI:1386489029
Name:MAHANAIM WELLNESS CENTER & IV HYDRATION LOUNGE
Entity type:Organization
Organization Name:MAHANAIM WELLNESS CENTER & IV HYDRATION LOUNGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH EDUCATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JASSETH
Authorized Official - Middle Name:MANNEISA
Authorized Official - Last Name:TAYLOR-PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-304-1751
Mailing Address - Street 1:5020 SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-2307
Mailing Address - Country:US
Mailing Address - Phone:301-304-1751
Mailing Address - Fax:667-300-2747
Practice Address - Street 1:5020 SUNNYSIDE AVE STE 202
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2307
Practice Address - Country:US
Practice Address - Phone:301-304-1751
Practice Address - Fax:667-300-2747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service