Provider Demographics
NPI:1992585947
Name:PURPLE DREAMS WELLNESS LLC
Entity type:Organization
Organization Name:PURPLE DREAMS WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SENIOR PHLEBOTOMIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:NRCPT
Authorized Official - Phone:443-739-2225
Mailing Address - Street 1:4709 HARFORD RD # 107
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-3261
Mailing Address - Country:US
Mailing Address - Phone:410-881-7044
Mailing Address - Fax:
Practice Address - Street 1:4709 HARFORD RD # 107
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-3261
Practice Address - Country:US
Practice Address - Phone:410-881-7044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty