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General NPI Number Information
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NPI Number | 1770966368
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Entity Type | Organization
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Legal Business Name | TEAM WELLNESS CENTER
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 2939 RUSSELL ST
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City | DETROIT
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State | MI
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Zip | 48207-4825
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Country | US
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Telephone | 313-396-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 2939 RUSSELL
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City | DETROIT
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State | MI
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Zip | 48207
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CYNTHIA FINNEGAN
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Credential |
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Telephone | 313-396-5300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | MI
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