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General NPI Number Information
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NPI Number | 1689383390
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Entity Type | Organization
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Legal Business Name | BLUE SPRING WELLNESS CENTER LLC
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Dates
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Enumeration Date | 11/21/2022
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 807- 809 E BALTIMORE ST STE 1A
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City | BALTIMORE
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State | MD
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Zip | 21202-5388
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Country | US
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Telephone | 410-646-8167
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Fax |
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Provider Business Mailing Address
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Address Line | 807 E BALTIMORE ST STE 1A
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City | BALTIMORE
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State | MD
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Zip | 21202-5388
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Country | US
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Telephone | 410-646-8167
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOTENESIA NJOROGE
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Credential | PMHNP
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Telephone | 106-468-1674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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