Provider Demographics
NPI:1336704758
Name:INNOVATIVE WELLNESS AND WEIGHT LOSS CENTER
Entity Type:Organization
Organization Name:INNOVATIVE WELLNESS AND WEIGHT LOSS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVLINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:724-635-0147
Mailing Address - Street 1:322 ARMBRUST RD STE 102
Mailing Address - Street 2:
Mailing Address - City:YOUNGWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15697-1816
Mailing Address - Country:US
Mailing Address - Phone:724-635-0147
Mailing Address - Fax:724-804-0703
Practice Address - Street 1:322 ARMBRUST RD STE 102
Practice Address - Street 2:
Practice Address - City:YOUNGWOOD
Practice Address - State:PA
Practice Address - Zip Code:15697-1816
Practice Address - Country:US
Practice Address - Phone:724-635-0147
Practice Address - Fax:724-804-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1811249196OtherNPI