Provider Demographics
NPI:1235404203
Name:GILEAD WELLNESS NETWORK INC.
Entity Type:Organization
Organization Name:GILEAD WELLNESS NETWORK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CYRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAGURU
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW,MA,MSW,CSW
Authorized Official - Phone:248-688-5004
Mailing Address - Street 1:21700 GREENFIELD RD
Mailing Address - Street 2:STE 210
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2581
Mailing Address - Country:US
Mailing Address - Phone:248-688-5004
Mailing Address - Fax:
Practice Address - Street 1:21700 GREENFIELD RD
Practice Address - Street 2:STE 210
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2581
Practice Address - Country:US
Practice Address - Phone:248-688-5004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801065695251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health