Provider Demographics
NPI:1518574474
Name:A.I.WELLNESS
Entity Type:Organization
Organization Name:A.I.WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROPER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:707-208-4325
Mailing Address - Street 1:11114 WORTHAM CREST CIR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5689
Mailing Address - Country:US
Mailing Address - Phone:707-208-4326
Mailing Address - Fax:
Practice Address - Street 1:11114 WORTHAM CREST CIR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5689
Practice Address - Country:US
Practice Address - Phone:707-208-4326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health