Healthcare Provider Details

I. General information

NPI: 1447003744
Provider Name (Legal Business Name): EASY CHOICE WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 MADISON AVE # 201
BALTIMORE MD
21201-2113
US

IV. Provider business mailing address

940 MADISON AVE # 201
BALTIMORE MD
21201-2113
US

V. Phone/Fax

Practice location:
  • Phone: 667-400-7072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. JESSICA JAMES OBUA
Title or Position: OWNER OPERATOR
Credential:
Phone: 410-622-7437