Provider Demographics
NPI:1982367975
Name:AFFIRMATIVE HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:AFFIRMATIVE HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JURG
Authorized Official - Middle Name:W J
Authorized Official - Last Name:OGGENFUSS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:414-614-5832
Mailing Address - Street 1:130 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1945
Mailing Address - Country:US
Mailing Address - Phone:860-502-9563
Mailing Address - Fax:860-855-6360
Practice Address - Street 1:130 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1945
Practice Address - Country:US
Practice Address - Phone:860-502-9563
Practice Address - Fax:860-855-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty