1265849228 NPI number — ADVANCED HEALTH AND WELLNESS CENTER OF NASHVILLE LLC

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 1265849228 NPI number — ADVANCED HEALTH AND WELLNESS CENTER OF NASHVILLE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED HEALTH AND WELLNESS CENTER OF NASHVILLE 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:
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:
1265849228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 GREAT OAKS TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WADSWORTH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44281-9430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-336-9500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 MALLORY LN
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37067-8233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-905-0120
Provider Business Practice Location Address Fax Number:
615-778-2900
Provider Enumeration Date:
07/22/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BUPP
Authorized Official First Name:
BRANDON
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
330-336-9500

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Q010891 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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