Healthcare Provider Details

I. General information

NPI: 1154087492
Provider Name (Legal Business Name): HOSA HEALTH AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 PARK AVE
WOONSOCKET RI
02895-5872
US

IV. Provider business mailing address

161 HAMILTON ST
WOONSOCKET RI
02895-5968
US

V. Phone/Fax

Practice location:
  • Phone: 401-633-2577
  • Fax:
Mailing address:
  • Phone: 401-633-2577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIAN E IDAHOSA
Title or Position: OWNER
Credential:
Phone: 401-633-2577