1396865226 NPI number — WE CARE FAMILY WELLNESS CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396865226 NPI number — WE CARE FAMILY WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WE CARE FAMILY WELLNESS CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LIVING WELL HOLISTIC CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396865226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6314 BLACK HORSE PIKE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
EGG HARBOR TOWNSHIP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-484-8333
Provider Business Mailing Address Fax Number:
609-484-8019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6314 BLACK HORSE PIKE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
EGG HARBOR TOWNSHIP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-484-8333
Provider Business Practice Location Address Fax Number:
609-484-8019
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALEJANDRO
Authorized Official First Name:
ADONIS
Authorized Official Middle Name:
Authorized Official Title or Position:
HEAD DOCTOR
Authorized Official Telephone Number:
609-484-8333

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  38MC00616300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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