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General NPI Number Information
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NPI Number | 1528383809
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Entity Type | Organization
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Legal Business Name | ADULT WELLNESS CENTER LLC
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Dates
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Enumeration Date | 03/30/2010
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Last Update Date | 04/05/2010
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Provider Practice Location Address
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Address Line | 348 BROADWAY AVE
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City | BEDFORD
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State | OH
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Zip | 44146-2605
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Country | US
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Telephone | 440-439-6400
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Fax | 440-439-6405
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Provider Business Mailing Address
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Address Line | 348 BROADWAY AVE
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City | BEDFORD
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State | OH
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Zip | 44146-2605
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Country | US
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Telephone | 440-439-6400
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Fax | 440-439-6405
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Authorized Official
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Title or Position | DIRECTOR OF NURSING
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Name | MS. SVETLANA ALANA LITVAK
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Credential | CRNP
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Telephone | 440-439-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | NP-6479
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License Number State | OH
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