Provider Demographics
NPI:1215691696
Name:WELLIV LLC
Entity type:Organization
Organization Name:WELLIV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DASHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:786-831-4348
Mailing Address - Street 1:698 NE 1ST AVE APT 3408
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1829
Mailing Address - Country:US
Mailing Address - Phone:786-831-4348
Mailing Address - Fax:302-216-1989
Practice Address - Street 1:837 LEE ST SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-2745
Practice Address - Country:US
Practice Address - Phone:786-831-4348
Practice Address - Fax:302-216-4348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care