JUST BREATHE RECOVERY AND WELLNESS CENTERS, LLC
Complete NPI Record 1174370506
Clinic/Center - Mental Health (Including Community Mental Health Center) in Brandywine, MD

NPI Status: Active since May 03, 2024

Contact Information

14306 KATHLEEN LN
BRANDYWINE, MD
ZIP 20613
Phone: (330) 256-3850

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Complete NPI Dataset

The following table represents the complete dataset for NPI number 1174370506. The table includes a list of all field names, values and definitions of the full NPI record. This dataset is available for download in CSV format using the "Download NPI" button below at the end of the table.

Name Value Definition
NPI1174370506The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameJUST BREATHE RECOVERY AND WELLNESS CENTERS, LLCThe name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address14306 KATHLEEN LNThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City NameBRANDYWINEThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameMDThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code206133012The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number3302563850The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address14306 KATHLEEN LNThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameBRANDYWINEThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameMDThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code206133012The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number3302563850The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date5/3/2024The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date5/3/2024The date that a record was last updated or changed.
Authorized Official Last NameJOHNSONThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameKARAThe first name of the authorized official.
Authorized Official Middle NameCAPRIEThe middle name of the authorized official.
Authorized Official Title or PositionOWNER, CLINICAL DIRECTORThe title or position of the authorized official.
Authorized Official Telephone Number3302563850The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1261QM0801XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1Y
Is Organization SubpartN
Authorized Official Credential TextLCSW-C, LCSW
NPI Certification Date5/3/2024