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General NPI Number Information
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NPI Number | 1881990414
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Entity Type | Organization
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Legal Business Name | WELLSTREET HOME THERAPY & MEDICAL
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Dates
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Enumeration Date | 01/29/2011
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 16626 E AVENUE OF THE FOUNTAINS STE. 102
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-8202
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Country | US
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Telephone | 480-836-2240
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Fax | 480-836-2217
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Provider Business Mailing Address
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Address Line | 16626 E AVENUE OF THE FOUNTAINS STE. 102
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-8202
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Country | US
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Telephone | 480-836-2240
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Fax | 480-836-2217
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. JASON P MARINO
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Credential | PT
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Telephone | 480-836-2240
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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 |
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License Number State |
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