Provider Demographics
NPI:1235611245
Name:WELCOME HOME WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:WELCOME HOME WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KETTIA
Authorized Official - Middle Name:CADET
Authorized Official - Last Name:CHERENFANT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:321-305-2765
Mailing Address - Street 1:7732 SILVER STAR RD STE 2
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-4752
Mailing Address - Country:US
Mailing Address - Phone:321-305-2765
Mailing Address - Fax:
Practice Address - Street 1:7732 SILVER STAR RD STE 2
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818
Practice Address - Country:US
Practice Address - Phone:321-305-2765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9237369261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care