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General NPI Number Information
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NPI Number | 1104256221
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Entity Type | Organization
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Legal Business Name | WELLNESS RESIDENTIAL SERVICES
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Dates
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Enumeration Date | 11/27/2013
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 260 NORTHLAND BLVD STE 216
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City | CINCINNATI
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State | OH
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Zip | 45246-3651
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Country | US
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Telephone | 513-969-4160
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Fax | 513-737-0018
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Provider Business Mailing Address
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Address Line | 260 NORTHLAND BLVD STE 216
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City | CINCINNATI
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State | OH
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Zip | 45246-3651
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Country | US
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Telephone | 513-969-4160
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Fax | 513-737-0018
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. IDORENYIN UDO FRED
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Credential | STUDENT
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Telephone | 513-969-4160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SH0200X
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Taxonomy Name | Home Health Clinical Nurse Specialist
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License Number |
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License Number State | OH
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