Healthcare Provider Details

I. General information

NPI: 1902262728
Provider Name (Legal Business Name): WELLNESS CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25900 GREENFIELD RD STE 411
OAK PARK MI
48237-1292
US

IV. Provider business mailing address

25900 GREENFIELD RD STE 411
OAK PARK MI
48237-1292
US

V. Phone/Fax

Practice location:
  • Phone: 248-703-0047
  • Fax:
Mailing address:
  • Phone: 248-703-0047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BERNARD L FOSTER
Title or Position: OWNER
Credential:
Phone: 248-703-0047