Provider Demographics
NPI:1225356066
Name:COMMUNITY WELLNESS CENTER
Entity Type:Organization
Organization Name:COMMUNITY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIA
Authorized Official - Middle Name:O
Authorized Official - Last Name:ANGELINI
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:207-582-2323
Mailing Address - Street 1:484 MAINE AVE STE 2D
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:ME
Mailing Address - Zip Code:04344-2903
Mailing Address - Country:US
Mailing Address - Phone:207-582-2323
Mailing Address - Fax:207-588-0294
Practice Address - Street 1:484 MAINE AVE STE 2D
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:ME
Practice Address - Zip Code:04344-2903
Practice Address - Country:US
Practice Address - Phone:207-582-2323
Practice Address - Fax:207-588-0294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1753111N00000X
MECR1840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty