Provider Demographics
| NPI: | 1619470218 |
|---|---|
| Name: | CARE 1ST WELLNESS, LLC |
| Entity type: | Organization |
| Organization Name: | CARE 1ST WELLNESS, LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | MELITA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | FRIEND |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 301-616-5707 |
| Mailing Address - Street 1: | 13180-F GARRETT HIGHWAY, PMB 46 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | OAKLAND |
| Mailing Address - State: | MD |
| Mailing Address - Zip Code: | 21550 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 71 MITCHELL DRIVE |
| Practice Address - Street 2: | |
| Practice Address - City: | OAKLAND |
| Practice Address - State: | MD |
| Practice Address - Zip Code: | 21550 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 301-616-5707 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2018-03-10 |
| Last Update Date: | 2025-04-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| MD | 101YA0400X, 101YM0800X, 101YP2500X, 163WG0000X | |
| 104100000X, 163WP0807X, 163WP0808X, 2084P0804X, 363LP0808X | ||
| MD | AT121 | 221700000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 163WG0000X | Nursing Service Providers | Registered Nurse | General Practice | Group - Multi-Specialty |
| No | 163WP0807X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health, Child & Adolescent | Group - Multi-Specialty |
| No | 163WP0808X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 221700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| WV | WVTPID007976 | Medicaid | |
| MD | 980333 | Medicaid | |
| WV | Y7983 | Other | THE HEALTH PLAN OF WEST VIRGINIA |