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NPI Code Detail

MEDICARE: WELLLIFE NETWORK INC

MEDICARE: WELLLIFE NETWORK INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320600000XIntellectual and/or Developmental Disabilities Residential Treatment Facility01530749NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356405880
Entity Type Code : Organization
Provider Name (Legal Business Name) : WELLLIFE NETWORK INC
Provider Business Mailing Address
First Line : 142-02 20TH AVENUE
Second Line :
City : FLUSHING
State : NY
Zip : 11351-9712
Country : US
Telephone Number : 718-559-0516
Fax Number : 718-762-6140
Provider Business Practice Location Address
First Line : 10154 117TH ST
Second Line :
City : SOUTH RICHMOND HILL
State : NY
Zip : 11419-1906
Country : US
Telephone Number : 718-445-4700
Fax Number :
Authorized Official
Title or Position : SENIOR VICE PRESIDENT - CFO
Name : MS. LORI ALAMEDA
Credential :
Telephone Number : 347-542-5616
Provider Enumeration Date : 12/20/2006
Last Update Date : 12/16/2020

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