Organization · NPI-2

Blessed Vine Healthcare Services LLC

Clinic/Center, Mental Health (Including Community Mental Health Center) · Waldorf, MD

NPI number1619799459
StatusActive
Last updated in NPPESOct 31, 2024

Details

NPI
1619799459
Entity type
Organization (NPI-2)
Legal business name
Blessed Vine Healthcare Services LLC
Organization subpart
No
Enumeration date
Oct 31, 2024
Certification date
Oct 24, 2024
Last updated
Oct 31, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––Yes

Practice location

3261 Old Washington Rd Ste 2020
Waldorf, MD 20602-3231

Phone 240-725-4037

Mailing address

3261 Old Washington Rd Ste 2020
Waldorf, MD 20602-3231

Phone 240-725-4037

Authorized official

Barbara Buxton
Owner
2407254037

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