Healthcare Provider Details

I. General information

NPI: 1609475292
Provider Name (Legal Business Name): KEW WELLNESS CENTER 1, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 LANGSTON AVE
NEW PORT RICHEY FL
34653-1014
US

IV. Provider business mailing address

1793 EAGLE CREST DR
FLEMING ISLAND FL
32003-4521
US

V. Phone/Fax

Practice location:
  • Phone: 727-846-8487
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE WILGER
Title or Position: PRESIDENT
Credential:
Phone: 904-386-6636