1114430949 NPI number — WELL-BEING COMMUNITY CENTER, CORP.

Table of content: (NPI 1114430949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114430949 NPI number — WELL-BEING COMMUNITY CENTER, CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELL-BEING COMMUNITY CENTER, CORP.
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:
Provider Other Organization Name Type Code:
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:
1114430949
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2706 W ST ISABEL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33607-6382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-769-9571
Provider Business Mailing Address Fax Number:
813-492-8843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2706 W ST ISABEL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33607-6382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-769-9571
Provider Business Practice Location Address Fax Number:
813-492-8843
Provider Enumeration Date:
11/15/2017

Additional Information

Authorized Official

Authorized Official Last Name:
DE LA ROSA
Authorized Official First Name:
MARGARITA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
813-769-9571

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 101692101 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105731200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105731201 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105430400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 023311300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105482700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101692100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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