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General NPI Number Information
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NPI Number | 1295295525
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Entity Type | Organization
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Legal Business Name | WELL BL OPCO LLC
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Dates
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Enumeration Date | 03/22/2019
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 21111 ARRINGTON DR
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City | SELBYVILLE
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State | DE
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Zip | 19975-3607
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Country | US
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Telephone | 302-426-0808
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Fax |
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Provider Business Mailing Address
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Address Line | 21111 ARRINGTON DR
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City | SELBYVILLE
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State | DE
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Zip | 19975-3607
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Country | US
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Telephone | 302-426-0808
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Fax | 302-436-1081
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Authorized Official
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Title or Position | AUTHORIZED SIGNATORY
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Name | MR. KEITH PHILLIPS
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Credential |
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Telephone | 856-813-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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