Provider Demographics
NPI:1588434484
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:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASSETH
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR-PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP-BC
Authorized Official - Phone:609-906-8167
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:
Practice Address - Street 1:5020 SUNNYSIDE AVE
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center