Healthcare Provider Details

I. General information

NPI: 1346064086
Provider Name (Legal Business Name): WELLNESS CHAMPIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9021 MOONSTONE RD
NOTTINGHAM MD
21236-1923
US

IV. Provider business mailing address

9021 MOONSTONE RD
NOTTINGHAM MD
21236-1923
US

V. Phone/Fax

Practice location:
  • Phone: 443-678-8062
  • Fax:
Mailing address:
  • Phone: 443-678-8062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: TOLU MOJISOLA AROWOLO
Title or Position: ADVISOR
Credential:
Phone: 443-678-8062