Provider Demographics
NPI:1760985931
Name:WELLNESS WORKS LLC
Entity Type:Organization
Organization Name:WELLNESS WORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:YOUNGQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:603-547-5051
Mailing Address - Street 1:7 MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-2460
Mailing Address - Country:US
Mailing Address - Phone:603-547-5051
Mailing Address - Fax:
Practice Address - Street 1:7 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-2460
Practice Address - Country:US
Practice Address - Phone:603-547-5051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7155M302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization