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General NPI Number Information
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NPI Number | 1083778583
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Entity Type | Organization
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Legal Business Name | WELLLIFE NETWORK INC
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 5232 72ND PL
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City | MASPETH
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State | NY
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Zip | 11378-1516
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Country | US
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Telephone | 718-779-7931
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Fax |
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Provider Business Mailing Address
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Address Line | 142-02 20TH AVENUE
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City | FLUSHING
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State | NY
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Zip | 11351-9712
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Country | US
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Telephone | 718-559-0516
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Fax | 718-762-6140
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT - CFP
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Name | MS. LORI ALAMEDA
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Credential |
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Telephone | 347-542-5616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 01203025
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License Number State | NY
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