Provider Demographics
NPI:1467071894
Name:WELLBE SENIOR MEDICAL LLC
Entity Type:Organization
Organization Name:WELLBE SENIOR MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASCELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-517-1124
Mailing Address - Street 1:20 W KINZIE ST STE 17
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-6393
Mailing Address - Country:US
Mailing Address - Phone:312-776-2422
Mailing Address - Fax:
Practice Address - Street 1:20 W KINZIE ST STE 17
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-6393
Practice Address - Country:US
Practice Address - Phone:312-776-2422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management