Provider Demographics
NPI:1174000327
Name:RUDELLA'S TOTAL HEALTH AND WELLNESS CENTER
Entity Type:Organization
Organization Name:RUDELLA'S TOTAL HEALTH AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-236-1268
Mailing Address - Street 1:6001 ARGYLE FOREST BLVD STE 21
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6127
Mailing Address - Country:US
Mailing Address - Phone:904-438-2797
Mailing Address - Fax:
Practice Address - Street 1:8410 CHESWICK OAK AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-7352
Practice Address - Country:US
Practice Address - Phone:904-438-2797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management