Provider Demographics
NPI:1538647896
Name:WALDEN HEALTHCARE, LLC.
Entity Type:Organization
Organization Name:WALDEN HEALTHCARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLOWACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-614-7624
Mailing Address - Street 1:36711 AMERICAN WAY STE A
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4062
Mailing Address - Country:US
Mailing Address - Phone:440-455-3348
Mailing Address - Fax:440-895-5050
Practice Address - Street 1:25200 CENTER RIDGE RD STE 2301
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4141
Practice Address - Country:US
Practice Address - Phone:440-455-3348
Practice Address - Fax:440-895-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.047318207R00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty