Provider Demographics
NPI:1467980524
Name:WELLNESS TRANSPORTATION INC
Entity Type:Organization
Organization Name:WELLNESS TRANSPORTATION INC
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:R
Authorized Official - Last Name:OTUMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-307-1845
Mailing Address - Street 1:52 CLAREMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:605 BROAD ST APT 18
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-1846
Practice Address - Country:US
Practice Address - Phone:781-307-1845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care