Provider Demographics
NPI:1508120056
Name:LIFESTYLE AND WELLNESS INSTITUTE LLC
Entity Type:Organization
Organization Name:LIFESTYLE AND WELLNESS INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:ERVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-224-1318
Mailing Address - Street 1:7395 HODGSON MEMORIAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-1518
Mailing Address - Country:US
Mailing Address - Phone:912-220-3580
Mailing Address - Fax:
Practice Address - Street 1:7395 HODGSON MEMORIAL DR STE 101
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1518
Practice Address - Country:US
Practice Address - Phone:912-220-3580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center