Provider Demographics
NPI:1528383809
Name:ADULT WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ADULT WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:ALANA
Authorized Official - Last Name:LITVAK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:440-439-6400
Mailing Address - Street 1:348 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2605
Mailing Address - Country:US
Mailing Address - Phone:440-439-6400
Mailing Address - Fax:440-439-6405
Practice Address - Street 1:348 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2605
Practice Address - Country:US
Practice Address - Phone:440-439-6400
Practice Address - Fax:440-439-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-6479261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service