Provider Demographics
NPI:1124209523
Name:GREENVILLE WELLNESS CENTER, LLP
Entity type:Organization
Organization Name:GREENVILLE WELLNESS CENTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:S
Authorized Official - Last Name:AARON
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:972-722-4045
Mailing Address - Street 1:4006 WELLINGTON ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7828
Mailing Address - Country:US
Mailing Address - Phone:972-722-4045
Mailing Address - Fax:972-722-4087
Practice Address - Street 1:4006 WELLINGTON ST
Practice Address - Street 2:SUITE 110
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7828
Practice Address - Country:US
Practice Address - Phone:972-722-4045
Practice Address - Fax:972-722-4087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)