MEDICARE: GILEAD WELLNESS NETWORK INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1174790174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILEAD WELLNESS NETWORK INC

Provider Business Mailing Address
First Line	:	11000 W MCNICHOLS RD
Second Line	:	SUITE 312
City	:	DETROIT
State	:	MI
Zip	:	48221-2357
Country	:	US
Telephone Number	:	248-688-5004
Fax Number	:	248-968-5939

Provider Business Practice Location Address
First Line	:	11000 W MCNICHOLS RD
Second Line	:	SUITE 312
City	:	DETROIT
State	:	MI
Zip	:	48221-2357
Country	:	US
Telephone Number	:	248-688-5004
Fax Number	:	248-968-5939

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CYRIL C NWAGURU
Credential	:	MA MSW LMSW CSW
Telephone Number	:	248-968-8556

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	12/16/2008

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