Provider Demographics
NPI:1871312355
Name:TRUE PHOENIX WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:TRUE PHOENIX WELLNESS CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOLAYE
Authorized Official - Middle Name:V
Authorized Official - Last Name:ADELEYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-941-7999
Mailing Address - Street 1:2316 E JOPPA RD FL 2
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2808
Mailing Address - Country:US
Mailing Address - Phone:410-941-7999
Mailing Address - Fax:443-687-8705
Practice Address - Street 1:2316 E JOPPA RD FL 2
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2808
Practice Address - Country:US
Practice Address - Phone:410-941-7999
Practice Address - Fax:443-687-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty