Provider Demographics
NPI:1144716192
Name:GUADALUPE CENTER FOR HEALING
Entity type:Organization
Organization Name:GUADALUPE CENTER FOR HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:478-250-7092
Mailing Address - Street 1:717 COLLIER CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-9449
Mailing Address - Country:US
Mailing Address - Phone:478-250-7092
Mailing Address - Fax:
Practice Address - Street 1:1643 LIBERTY RD STE 105
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6545
Practice Address - Country:US
Practice Address - Phone:478-250-7092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDW18924431261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty