MEDICARE: WELLLIFE 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	01141313	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447314042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLLIFE NETWORK INC

Provider Business Mailing Address
First Line	:	142-02 20TH AVENUE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11351-9712
Country	:	US
Telephone Number	:	718-559-0516
Fax Number	:	718-762-6140

Provider Business Practice Location Address
First Line	:	2729 BUTLER ST
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11369-1927
Country	:	US
Telephone Number	:	718-478-1397
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MS. LORI ALAMEDA
Credential	:
Telephone Number	:	347-542-5616

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	12/16/2020

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