MEDICARE: MARYLAND WELLNESS AND RECOVERY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1538997127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYLAND WELLNESS AND RECOVERY LLC

Provider Business Mailing Address
First Line	:	4208 GARRETT PARK RD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-4830
Country	:	US
Telephone Number	:	240-242-4225
Fax Number	:	240-559-1571

Provider Business Practice Location Address
First Line	:	4208 GARRETT PARK RD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-4830
Country	:	US
Telephone Number	:	240-242-4225
Fax Number	:	240-559-1571

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SAHAR GERAMIFAR
Credential	:
Telephone Number	:	240-242-4225

Provider Enumeration Date	:	07/24/2024
Last Update Date	:	07/24/2024

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