Provider Demographics
NPI:1427695808
Name:CONTINUUM WELLNESS CENTER LLC.
Entity type:Organization
Organization Name:CONTINUUM WELLNESS CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LYSTRA
Authorized Official - Middle Name:EASTLYN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-788-6727
Mailing Address - Street 1:2 W ROLLING XRDS STE 111
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6204
Mailing Address - Country:US
Mailing Address - Phone:410-788-6727
Mailing Address - Fax:
Practice Address - Street 1:7310 RITCHIE HWY STE 405
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3092
Practice Address - Country:US
Practice Address - Phone:410-788-6727
Practice Address - Fax:410-788-6729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD870014101Medicaid