Provider Demographics
NPI:1710655204
Name:REGION HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:REGION HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-308-9459
Mailing Address - Street 1:112B MILL ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-1714
Mailing Address - Country:US
Mailing Address - Phone:219-306-0617
Mailing Address - Fax:
Practice Address - Street 1:112B MILL ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-1714
Practice Address - Country:US
Practice Address - Phone:219-306-0617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty