Provider Demographics
NPI:1124334099
Name:EAST-WEST WELLNESS CENTER
Entity type:Organization
Organization Name:EAST-WEST WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:I
Authorized Official - Last Name:BOLHOVITINOVA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:215-322-7733
Mailing Address - Street 1:649 2ND STREET PIKE STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3996
Mailing Address - Country:US
Mailing Address - Phone:215-322-7733
Mailing Address - Fax:215-322-7743
Practice Address - Street 1:649 2ND STREET PIKE STE B
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3996
Practice Address - Country:US
Practice Address - Phone:215-322-7733
Practice Address - Fax:215-322-7743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-29
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000721261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center