Provider Demographics
NPI:1629494067
Name:ARENA CARE AND WELLNESS CENTER
Entity Type:Organization
Organization Name:ARENA CARE AND WELLNESS CENTER
Other - Org Name:ARENA WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:CARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-250-1507
Mailing Address - Street 1:930 ATLANTIC AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238
Mailing Address - Country:US
Mailing Address - Phone:718-230-3301
Mailing Address - Fax:
Practice Address - Street 1:930 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-3101
Practice Address - Country:US
Practice Address - Phone:718-230-3301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARENA CARE & WELLNESS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011085-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty