Healthcare Provider Details

I. General information

NPI: 1235849159
Provider Name (Legal Business Name): THE ELYSIAN FIELDS OPTIMUM WELLNESS AND MENTAL HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N HOWARD ST
BALTIMORE MD
21218-5609
US

IV. Provider business mailing address

2222 N HOWARD ST
BALTIMORE MD
21218-5609
US

V. Phone/Fax

Practice location:
  • Phone: 410-624-5037
  • Fax:
Mailing address:
  • Phone: 410-624-5037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: ARTHUR GRIFFIN
Title or Position: CEO
Credential:
Phone: 410-367-0708