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General NPI Number Information
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NPI Number | 1013479617
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Entity Type | Organization
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Legal Business Name | PARTNERS IN WELLNESS MANAGEMENT, LLC
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 2470 COLLINGWOOD ST RM 327
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City | DETROIT
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State | MI
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Zip | 48206-1500
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Country | US
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Telephone | 313-914-2296
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Fax | 313-436-4152
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Provider Business Mailing Address
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Address Line | 2470 COLLINGWOOD ST RM 327
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City | DETROIT
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State | MI
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Zip | 48206-1500
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Country | US
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Telephone | 313-914-2296
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Fax | 313-436-4152
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CLEAMON MOORER JR.
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Credential | DBA
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Telephone | 313-740-9716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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