Provider Demographics
NPI:1164913919
Name:PANACEA RECOVERY ADVOCATES & WELLNESS
Entity Type:Organization
Organization Name:PANACEA RECOVERY ADVOCATES & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:234-312-9127
Mailing Address - Street 1:1101 PORTAGE TRAIL EXT STE 3
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-8250
Mailing Address - Country:US
Mailing Address - Phone:234-312-9127
Mailing Address - Fax:234-312-9579
Practice Address - Street 1:1101 PORTAGE TRAIL EXT STE 3
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-8250
Practice Address - Country:US
Practice Address - Phone:234-312-9127
Practice Address - Fax:234-312-9579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-27
Last Update Date:2018-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
OH251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health