Provider Demographics
NPI:1124364492
Name:MEDCARE WELLNESS PROVIDERS CORP.
Entity type:Organization
Organization Name:MEDCARE WELLNESS PROVIDERS CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-683-2223
Mailing Address - Street 1:6750 N ANDREWS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2173
Mailing Address - Country:US
Mailing Address - Phone:888-902-7114
Mailing Address - Fax:954-302-7635
Practice Address - Street 1:2311 LEE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1749
Practice Address - Country:US
Practice Address - Phone:888-902-7114
Practice Address - Fax:954-302-7635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare