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General NPI Number Information
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NPI Number | 1366051708
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Entity Type | Organization
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Legal Business Name | SENIOR WELLNESS GROUP
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Dates
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Enumeration Date | 07/30/2020
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 2473 NORTH RD NE
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City | WARREN
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State | OH
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Zip | 44483-3054
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Country | US
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Telephone | 330-372-2251
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 AUBURN DR SUITE 200
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City | BEACHWOOD
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State | OH
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Zip | 44122-4314
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Country | US
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Telephone | 440-343-6955
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. KERRY NEAL
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Credential |
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Telephone | 440-343-6955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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