Provider Demographics
NPI:1114430949
Name:WELL-BEING COMMUNITY CENTER, CORP.
Entity Type:Organization
Organization Name:WELL-BEING COMMUNITY CENTER, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-769-9571
Mailing Address - Street 1:2706 W ST ISABEL ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6382
Mailing Address - Country:US
Mailing Address - Phone:813-769-9571
Mailing Address - Fax:813-492-8843
Practice Address - Street 1:2706 W ST ISABEL ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6382
Practice Address - Country:US
Practice Address - Phone:813-769-9571
Practice Address - Fax:813-492-8843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101692101Medicaid
FL105731200Medicaid
FL105731201Medicaid
FL105430400Medicaid
FL023311300Medicaid
FL105482700Medicaid
FL101692100Medicaid