Healthcare Provider Details

I. General information

NPI: 1033899406
Provider Name (Legal Business Name): A VILLAGE WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 PERSHING DR STE 202
SILVER SPRING MD
20910-4439
US

IV. Provider business mailing address

804 PERSHING DR STE 202
SILVER SPRING MD
20910-4439
US

V. Phone/Fax

Practice location:
  • Phone: 301-328-7162
  • Fax:
Mailing address:
  • Phone: 301-328-7162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER LANGLEY
Title or Position: CEO
Credential:
Phone: 202-578-0908