Healthcare Provider Details

I. General information

NPI: 1689308728
Provider Name (Legal Business Name): WELLBOUND II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7424 13TH AVE
BROOKLYN NY
11228-2021
US

IV. Provider business mailing address

7424 13TH AVE
BROOKLYN NY
11228-2021
US

V. Phone/Fax

Practice location:
  • Phone: 718-400-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RAPHAEL WEISS
Title or Position: CFO
Credential:
Phone: 917-837-2297