Provider Demographics
NPI: | 1619470218 |
---|---|
Name: | CARE 1ST WELLNESS, LLC |
Entity type: | Organization |
Organization Name: | CARE 1ST WELLNESS, LLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MELITA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FRIEND |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 301-616-5707 |
Mailing Address - Street 1: | 13180-F GARRETT HIGHWAY, PMB 46 |
Mailing Address - Street 2: | |
Mailing Address - City: | OAKLAND |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21550 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 71 MITCHELL DRIVE |
Practice Address - Street 2: | |
Practice Address - City: | OAKLAND |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21550 |
Practice Address - Country: | US |
Practice Address - Phone: | 301-616-5707 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-03-10 |
Last Update Date: | 2025-04-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | 101YA0400X, 101YM0800X, 101YP2500X, 163WG0000X | |
104100000X, 163WP0807X, 163WP0808X, 2084P0804X, 363LP0808X | ||
MD | AT121 | 221700000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 163WG0000X | Nursing Service Providers | Registered Nurse | General Practice | Group - Multi-Specialty |
No | 163WP0807X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health, Child & Adolescent | Group - Multi-Specialty |
No | 163WP0808X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
No | 221700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WV | WVTPID007976 | Medicaid | |
MD | 980333 | Medicaid | |
WV | Y7983 | Other | THE HEALTH PLAN OF WEST VIRGINIA |