Healthcare Provider Details

I. General information

NPI: 1780080861
Provider Name (Legal Business Name): PROVIDER WELLNESS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26105 ORCHARD LAKE RD SUITE 105
FARMINGTON HILLS MI
48334-4576
US

IV. Provider business mailing address

26105 ORCHARD LAKE RD SUITE 105
FARMINGTON HILLS MI
48334-4576
US

V. Phone/Fax

Practice location:
  • Phone: 248-613-7622
  • Fax: 248-477-5552
Mailing address:
  • Phone: 248-613-7622
  • Fax: 248-477-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NAVID SAYED
Title or Position: CEO
Credential:
Phone: 248-613-7622