Provider Demographics
NPI:1982361358
Name:BETA HEALTH WEIGHT MANAGEMENT CENTER AND MEDI SPA LLC
Entity type:Organization
Organization Name:BETA HEALTH WEIGHT MANAGEMENT CENTER AND MEDI SPA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:NDI
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:443-762-6390
Mailing Address - Street 1:5150 GLENN DALE WOODS CT
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9113
Mailing Address - Country:US
Mailing Address - Phone:443-762-6390
Mailing Address - Fax:
Practice Address - Street 1:10220 S DOLFIELD RD STE 102
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3660
Practice Address - Country:US
Practice Address - Phone:443-762-6390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-20
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center