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General NPI Number Information
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NPI Number | 1487238960
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Entity Type | Organization
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Legal Business Name | MARATHON COMMUNITY WELLNESS. INC.
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 09/11/2021
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Provider Practice Location Address
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Address Line | 6340 SECURITY BLVD STE B34 FIRST FLOOR
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City | GWYNN OAK
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State | MD
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Zip | 21207-5173
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Country | US
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Telephone | 443-273-4570
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Fax |
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Provider Business Mailing Address
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Address Line | 6340 SECURITY BLVD SUITE B34, FIRST FLOOR
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City | GWYNN OAK
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State | MD
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Zip | 21207-5173
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Country | US
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Telephone | 443-273-4570
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | BYRON RANDALL
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Credential |
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Telephone | 443-273-4570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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