=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285512632
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PUREBALANCE HEALTH & WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2025
-----------------------------------------------------
Last Update Date | 08/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5310 OLD COURT RD STE 304
-----------------------------------------------------
City | RANDALLSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21133-6202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-400-5230
-----------------------------------------------------
Fax | 410-401-0221
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 61
-----------------------------------------------------
City | RANDALLSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21133-0061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-400-5230
-----------------------------------------------------
Fax | 410-401-0221
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CHEZO NOJANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 443-280-3004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------