Provider Demographics
NPI:1457977100
Name:APEX WELLNESS GROUP, LLC
Entity type:Organization
Organization Name:APEX WELLNESS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-984-8257
Mailing Address - Street 1:118 E 25TH ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5281
Mailing Address - Country:US
Mailing Address - Phone:410-982-8257
Mailing Address - Fax:
Practice Address - Street 1:118 E 25TH ST UNIT 2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5281
Practice Address - Country:US
Practice Address - Phone:410-982-8257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD200509863OtherBEHAVIORAL HEALTH LICENSE