Healthcare Provider Details

I. General information

NPI: 1710933072
Provider Name (Legal Business Name): WELLNESS COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132A GEORGE M COHAN BLVD
PROVIDENCE RI
02903-4410
US

IV. Provider business mailing address

132A GEORGE M COHAN BLVD
PROVIDENCE RI
02903-4410
US

V. Phone/Fax

Practice location:
  • Phone: 401-461-0662
  • Fax: 401-461-3825
Mailing address:
  • Phone: 401-461-0662
  • Fax: 401-461-3825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RANDALL WAYNE LINN
Title or Position: PRESIDENT
Credential:
Phone: 401-461-0662