Provider Demographics
NPI:1316001902
Name:WELLLIFE NETWORK INC
Entity Type:Organization
Organization Name:WELLLIFE NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAMEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-542-5616
Mailing Address - Street 1:2244 119TH ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-2516
Mailing Address - Country:US
Mailing Address - Phone:718-445-4700
Mailing Address - Fax:
Practice Address - Street 1:8806 195TH PL
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2029
Practice Address - Country:US
Practice Address - Phone:718-776-0280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01116678320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01116678Medicaid