Provider Demographics
NPI:1518238609
Name:PLEASANT BAY HEALTH AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:PLEASANT BAY HEALTH AND WELLNESS CENTER LLC
Other - Org Name:THE WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:508-240-3500
Mailing Address - Street 1:383 S ORLEANS RD
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-2870
Mailing Address - Country:US
Mailing Address - Phone:508-240-3500
Mailing Address - Fax:508-240-1969
Practice Address - Street 1:64 WOODLANDS WAY
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631
Practice Address - Country:US
Practice Address - Phone:508-240-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty