ETHOS HEALTH MARYLAND 1, LLC


Address: 4940 Campbell Blvd Ste 130, Nottingham, MD 21236-5910
Phone: 4108706498

ETHOS HEALTH MARYLAND 1, LLC (NPI# 1144888025) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1144888025
Entity Type Organization
Organization Name ETHOS HEALTH MARYLAND 1, LLC
Practice Address 4940 Campbell Blvd Ste 130
Nottingham
MD 21236-5910
Mailing Address 1541 Se 17th St
Ocala
FL 34471-4607
Practice Telephone 4108706498
Practice Fax Number 4108706555
Mailing Telephone 3527325590
Mailing Fax Number 3527320292
Enumeration Date 2019-06-05
Last Update Date 2019-07-19
Authorized Official Name JONATHAN RAY WALKER (OWNER)
Authorized Official Telephone 3527325590
Authorized Official Credential DC
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QM1300X Clinic/Center
Specialization: Multi-Specialty
Ambulatory Health Care Facilities

Office Location

Street Address 4940 CAMPBELL BLVD STE 130
City NOTTINGHAM
State MD
Zip Code 21236-5910

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1083257646 Matthew Peter Halstad Behavioral Analyst 8090 Sandpiper Circle, Nottingham, MD 21236 2019-10-25
1609331602 Tunisia Buise Social Worker 4132 E. Joppa Road Ste. 110-#1248, Baltimore, MD 21236 2019-02-04
1730673047 Golden Jemz Adult Medical Day Clinic/Center 5020 Cambell Blvd, Nottingham, MD 21236 2018-06-20
1487143400 For Eyes Optical of Pa Eyewear Supplier (Equipment, not the service) 7984 Honeygo Blvd, Nottingham, MD 21236 2018-05-04
1619478922 Weis Markets, Inc. Pharmacy 7927 Belair Rd Ste S, Nottingham, MD 21236 2018-02-22
1285133918 Joan Rosa Keller Behavior Technician 3501 Taylor Ave., Baltimore, MD 21236 2018-02-08
1205341146 Ebony Watkins Nurse Practitioner 8940 Kilkenny Circle, Nottingham, MD 21236 2017-12-13
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Taxonomy Information

Taxonomy Code 261QM1300X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Multi-Specialty

Taxonomy Definition

Definition to come...

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Competitor

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City NOTTINGHAM
Zip Code 21236

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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