Provider Demographics
NPI:1053815308
Name:OHLALA WELLNESS CENTER CORPORATION
Entity Type:Organization
Organization Name:OHLALA WELLNESS CENTER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAID
Authorized Official - Middle Name:
Authorized Official - Last Name:AIT ALLA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:302-494-6377
Mailing Address - Street 1:1102 BALTIMORE PIKE STE 111
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1058
Mailing Address - Country:US
Mailing Address - Phone:302-494-6377
Mailing Address - Fax:
Practice Address - Street 1:1102 BALTIMORE PIKE STE 111
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1058
Practice Address - Country:US
Practice Address - Phone:302-494-6377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service