Provider Demographics
NPI:1508642901
Name:FAMILY PREVENTIVE CARE WELLNESS CENTER
Entity Type:Organization
Organization Name:FAMILY PREVENTIVE CARE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:AVA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-526-7249
Mailing Address - Street 1:7201 BELTZ DR
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-4601
Mailing Address - Country:US
Mailing Address - Phone:301-526-7249
Mailing Address - Fax:
Practice Address - Street 1:5850 WATERLOO RD STE 140
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1944
Practice Address - Country:US
Practice Address - Phone:301-526-7249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-01
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care