Provider Demographics
NPI:1972138865
Name:ASPEN WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:ASPEN WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHABILITATION SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCTAGGART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-362-7439
Mailing Address - Street 1:217 GLENN ST STE 401
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2560
Mailing Address - Country:US
Mailing Address - Phone:240-362-7439
Mailing Address - Fax:
Practice Address - Street 1:217 GLENN ST STE 401
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2560
Practice Address - Country:US
Practice Address - Phone:240-362-7439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPEN WELLNESS CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD777550400Medicaid