Provider Demographics
NPI:1215528641
Name:NORTHEAST WELLNESS, LLC
Entity type:Organization
Organization Name:NORTHEAST WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-469-5320
Mailing Address - Street 1:71 COMMERCIAL ST # 166
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-1320
Mailing Address - Country:US
Mailing Address - Phone:617-848-4417
Mailing Address - Fax:
Practice Address - Street 1:22 MILL ST STE 108
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4738
Practice Address - Country:US
Practice Address - Phone:617-848-4417
Practice Address - Fax:617-848-4417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty