Provider Demographics
NPI:1063059244
Name:PVD CARES WELLNESS CENTER LLC
Entity type:Organization
Organization Name:PVD CARES WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:EFFIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:323-770-6210
Mailing Address - Street 1:126 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4476
Mailing Address - Country:US
Mailing Address - Phone:401-753-2526
Mailing Address - Fax:401-235-4152
Practice Address - Street 1:126 PROSPECT ST STE 105
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4429
Practice Address - Country:US
Practice Address - Phone:401-753-2526
Practice Address - Fax:401-235-4152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty