Provider Demographics
NPI:1588477277
Name:MONTGOMERY WELLNESS HUB LLC
Entity type:Organization
Organization Name:MONTGOMERY WELLNESS HUB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:KOLAWOLE
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-404-7336
Mailing Address - Street 1:6 W WASHINGTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-4830
Mailing Address - Country:US
Mailing Address - Phone:240-246-7837
Mailing Address - Fax:240-246-7911
Practice Address - Street 1:6 W WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4830
Practice Address - Country:US
Practice Address - Phone:240-246-7837
Practice Address - Fax:240-246-7911
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTGOMERY WELLNESS HUB LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health