Organization · NPI-2

Ketamine Health & Restoration, LLC.

Anesthesiology · Laurel, MD

NPI number1780461582
StatusActive
Last updated in NPPESMay 17, 2024

Details

NPI
1780461582
Entity type
Organization (NPI-2)
Legal business name
Ketamine Health & Restoration, LLC.
Organization subpart
No
Enumeration date
Sep 13, 2023
Certification date
May 17, 2024
Last updated
May 17, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207L00000X Anesthesiology––Yes

Practice location

585 Main St Ste 145
Laurel, MD 20707-4354

Phone 301-298-8267 · Fax 301-517-9386

Mailing address

585 Main St Ste 145
Laurel, MD 20707-4354

Phone 301-298-8267 · Fax 301-517-9386

Authorized official

Tiffany Owens
Owner
3012988267

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