Healthcare Provider Details

I. General information

NPI: 1003754797
Provider Name (Legal Business Name): ALIVE WELLNESS HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12312 QUAIL WOODS DR
GERMANTOWN MD
20874-1542
US

IV. Provider business mailing address

12312 QUAIL WOODS DR
GERMANTOWN MD
20874-1542
US

V. Phone/Fax

Practice location:
  • Phone: 240-421-8408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHANTAL HLONTOR
Title or Position: PRESIDENT
Credential: DR
Phone: 240-421-8408