Healthcare Provider Details

I. General information

NPI: 1376180398
Provider Name (Legal Business Name): MAZWI HOLISTIC INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 W FAYETTE ST
BALTIMORE MD
21223-1708
US

IV. Provider business mailing address

1705 W FAYETTE ST
BALTIMORE MD
21223-1708
US

V. Phone/Fax

Practice location:
  • Phone: 443-282-8949
  • Fax: 410-947-5306
Mailing address:
  • Phone: 410-947-1700
  • Fax: 410-947-5306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. ANGEL MAZWI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 443-282-8949