Provider Demographics
NPI:1154087492
Name:HOSA HEALTH AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:HOSA HEALTH AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:IDAHOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-633-2577
Mailing Address - Street 1:161 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-5968
Mailing Address - Country:US
Mailing Address - Phone:401-633-2577
Mailing Address - Fax:
Practice Address - Street 1:867 PARK AVE
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-5872
Practice Address - Country:US
Practice Address - Phone:401-633-2577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty