Provider Demographics
NPI:1043772023
Name:LILYBROOK WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:LILYBROOK WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HSIAO-PING
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-509-1789
Mailing Address - Street 1:176 WAYNEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ARIEL
Mailing Address - State:PA
Mailing Address - Zip Code:18436-4285
Mailing Address - Country:US
Mailing Address - Phone:703-509-1789
Mailing Address - Fax:
Practice Address - Street 1:176 WAYNEWOOD RD
Practice Address - Street 2:
Practice Address - City:LAKE ARIEL
Practice Address - State:PA
Practice Address - Zip Code:18436-4285
Practice Address - Country:US
Practice Address - Phone:703-509-1789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-01
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty