MEDICARE: ASPIRA WELLNESS & EDUCATION CENTER 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1932114816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPIRA WELLNESS & EDUCATION CENTER INC.

Provider Business Mailing Address
First Line	:	5500 E ATHERTON ST
Second Line	:	SUITE 316
City	:	LONG BEACH
State	:	CA
Zip	:	90815-4016
Country	:	US
Telephone Number	:	562-493-3201
Fax Number	:	562-493-3753

Provider Business Practice Location Address
First Line	:	5500 E ATHERTON ST
Second Line	:	SUITE 416
City	:	LONG BEACH
State	:	CA
Zip	:	90815-4016
Country	:	US
Telephone Number	:	562-493-1496
Fax Number	:	562-493-2092

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. WESTON LANGE
Credential	:
Telephone Number	:	209-669-2583

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	08/06/2010

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