Provider Demographics
NPI:1154566958
Name:PUBLIC WELLNESS ASSISTANCE INC.
Entity type:Organization
Organization Name:PUBLIC WELLNESS ASSISTANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ESTEBAN
Authorized Official - Middle Name:DAGOBERTO
Authorized Official - Last Name:MARICHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-773-2705
Mailing Address - Street 1:5119 HIGHLAND RD STE 391
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1915
Mailing Address - Country:US
Mailing Address - Phone:248-773-2705
Mailing Address - Fax:248-436-6238
Practice Address - Street 1:955 W HURON ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3727
Practice Address - Country:US
Practice Address - Phone:248-773-2705
Practice Address - Fax:248-436-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care