Provider Demographics
NPI:1417315466
Name:TEAM WELLNESS
Entity Type:Organization
Organization Name:TEAM WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-274-3700
Mailing Address - Street 1:921 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14799 DIX-TOLEDO RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48915
Practice Address - Country:US
Practice Address - Phone:734-324-8326
Practice Address - Fax:734-324-8327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health