Provider Demographics
NPI:1114104031
Name:WELLNESS CENTER 'LIMITED LIABILITY COMPANY'
Entity type:Organization
Organization Name:WELLNESS CENTER 'LIMITED LIABILITY COMPANY'
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:I
Authorized Official - Last Name:MOSKOW
Authorized Official - Suffix:
Authorized Official - Credentials:AP, PT
Authorized Official - Phone:954-675-5189
Mailing Address - Street 1:3315 NE 16TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1711
Mailing Address - Country:US
Mailing Address - Phone:954-675-5189
Mailing Address - Fax:954-565-6463
Practice Address - Street 1:3315 NE 16TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1711
Practice Address - Country:US
Practice Address - Phone:954-675-5189
Practice Address - Fax:954-565-6463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1364171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty