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General NPI Number Information
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NPI Number | 1760714448
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Entity Type | Organization
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Legal Business Name | WELLNESS SPECIALISTS, CORP
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Dates
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Enumeration Date | 02/05/2010
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Last Update Date | 02/05/2010
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Provider Practice Location Address
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Address Line | 330 E ROOSEVELT RD STE 2B4
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City | LOMBARD
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State | IL
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Zip | 60148-4640
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Country | US
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Telephone | 630-780-6956
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Fax | 630-873-2041
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Provider Business Mailing Address
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Address Line | 330 E ROOSEVELT RD STE 2B4
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City | LOMBARD
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State | IL
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Zip | 60148-4644
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Country | US
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Telephone | 630-780-6956
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Fax | 630-873-2041
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. IRENE G GONZAGA
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Credential | RN
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Telephone | 630-780-6956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1011185
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License Number State | IL
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