Provider Demographics
NPI:1427764844
Name:THE ELYSIAN FIELDS OPTIMUM WELLNESS AND MENTAL HEALTH GROUP, LLC
Entity type:Organization
Organization Name:THE ELYSIAN FIELDS OPTIMUM WELLNESS AND MENTAL HEALTH GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-367-0708
Mailing Address - Street 1:14625 BALTIMORE AVE STE 244
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4902
Mailing Address - Country:US
Mailing Address - Phone:913-226-9499
Mailing Address - Fax:
Practice Address - Street 1:3401 ELGIN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2605
Practice Address - Country:US
Practice Address - Phone:410-624-5037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility