1336849330 NPI number — AANANDHA WELL LLC

Table of content: EDWARD E. CHANCE P.A. (NPI 1710071840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336849330 NPI number — AANANDHA WELL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AANANDHA WELL LLC
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:
AANANDHA HEALTH AND WELLNESS
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:
1336849330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1168 MORGAN GROVE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHEPHERDSTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25443-4539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-362-3009
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 S DUKE ST STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHEPHERDSTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25443-4849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-362-3009
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2023

Additional Information

Authorized Official

Authorized Official Last Name:
COLLINS
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
304-362-3009

Provider Taxonomy Codes

  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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