Provider Demographics
NPI:1861147035
Name:LARGO WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:LARGO WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:NNEKA
Authorized Official - Last Name:OKANUME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-636-0977
Mailing Address - Street 1:14111 MARY BOWIE PKWY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8572
Mailing Address - Country:US
Mailing Address - Phone:301-636-0977
Mailing Address - Fax:240-770-6916
Practice Address - Street 1:1450 MERCANTILE LN STE 237
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5464
Practice Address - Country:US
Practice Address - Phone:301-636-0977
Practice Address - Fax:240-770-6916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care