Provider Demographics
NPI:1891391215
Name:SJL WELLNESS LLC
Entity type:Organization
Organization Name:SJL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUTHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-432-5270
Mailing Address - Street 1:3600 VILLAGE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6621
Mailing Address - Country:US
Mailing Address - Phone:402-432-7702
Mailing Address - Fax:402-939-0996
Practice Address - Street 1:3600 VILLAGE DR STE 120
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6621
Practice Address - Country:US
Practice Address - Phone:402-432-7702
Practice Address - Fax:402-939-0996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service