Provider Demographics
NPI:1376870626
Name:SENIOR WELLNESS GROUP OF ALABAMA
Entity Type:Organization
Organization Name:SENIOR WELLNESS GROUP OF ALABAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:TREMBA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-881-0225
Mailing Address - Street 1:100 N BANCROFT ST
Mailing Address - Street 2:ROOM 3 SUITE 1A
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2444
Mailing Address - Country:US
Mailing Address - Phone:251-928-7885
Mailing Address - Fax:888-794-1367
Practice Address - Street 1:100 N BANCROFT ST
Practice Address - Street 2:SUITE 1A ROOM 3
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2444
Practice Address - Country:US
Practice Address - Phone:251-928-7885
Practice Address - Fax:888-794-1367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2284332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6336930001Medicare NSC