Healthcare Provider Details

I. General information

NPI: 1124209523
Provider Name (Legal Business Name): GREENVILLE WELLNESS CENTER, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4006 WELLINGTON ST SUITE 110
GREENVILLE TX
75401-7828
US

IV. Provider business mailing address

4006 WELLINGTON ST SUITE 110
GREENVILLE TX
75401-7828
US

V. Phone/Fax

Practice location:
  • Phone: 972-722-4045
  • Fax: 972-722-4087
Mailing address:
  • Phone: 972-722-4045
  • Fax: 972-722-4087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: MS. LORI S. AARON
Title or Position: OWNER
Credential: R.T.
Phone: 972-722-4045