Provider Demographics
NPI:1114390101
Name:WELLNESS CARE CENTER LLC
Entity Type:Organization
Organization Name:WELLNESS CARE CENTER LLC
Other - Org Name:WELLSWOOD CARE CENTER II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:OLUWASOLA
Authorized Official - Last Name:AINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-234-0830
Mailing Address - Street 1:17633 MEADOWBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-5574
Mailing Address - Country:US
Mailing Address - Phone:857-234-0830
Mailing Address - Fax:813-232-2127
Practice Address - Street 1:17633 MEADOWBRIDGE DR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-5574
Practice Address - Country:US
Practice Address - Phone:857-234-0830
Practice Address - Fax:813-232-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12626310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility