Healthcare Provider Details

I. General information

NPI: 1285512632
Provider Name (Legal Business Name): PUREBALANCE HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 OLD COURT RD STE 304
RANDALLSTOWN MD
21133-6202
US

IV. Provider business mailing address

PO BOX 61
RANDALLSTOWN MD
21133-0061
US

V. Phone/Fax

Practice location:
  • Phone: 443-400-5230
  • Fax: 410-401-0221
Mailing address:
  • Phone: 443-400-5230
  • Fax: 410-401-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHEZO NOJANG
Title or Position: PRESIDENT
Credential:
Phone: 443-280-3004