Provider Demographics
NPI:1215541701
Name:NULIFE WELLNESS
Entity Type:Organization
Organization Name:NULIFE WELLNESS
Other - Org Name:NULIFE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAYON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:207-514-3562
Mailing Address - Street 1:361 POLAND SPRING RD
Mailing Address - Street 2:
Mailing Address - City:CASCO
Mailing Address - State:ME
Mailing Address - Zip Code:04015-4106
Mailing Address - Country:US
Mailing Address - Phone:207-514-3562
Mailing Address - Fax:
Practice Address - Street 1:759 ROOSEVELT TRL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5341
Practice Address - Country:US
Practice Address - Phone:207-514-3562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center