Healthcare Provider Details

I. General information

NPI: 1659006070
Provider Name (Legal Business Name): WELINK GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 W CARMEN ST
PHOENIX AZ
85041-3778
US

IV. Provider business mailing address

1612 W CARMEN ST
PHOENIX AZ
85041-3778
US

V. Phone/Fax

Practice location:
  • Phone: 773-892-5454
  • Fax:
Mailing address:
  • Phone: 773-892-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: HODAL BIZIMUNGU
Title or Position: ADMINISTRATOR
Credential:
Phone: 773-892-5454