Healthcare Provider Details

I. General information

NPI: 1508218512
Provider Name (Legal Business Name): SENIOR WELLNESS AND CARE CONTINUUM ALLIANCE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S WILLIS ST
VISALIA CA
93291-6105
US

IV. Provider business mailing address

4059 VIRGILIA DR
TROY MI
48098-4638
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-4080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberC143116
License Number StateCA

VIII. Authorized Official

Name: CHRISTOPHER WILLIAMS
Title or Position: CEO
Credential: MD
Phone: 313-903-0043