Provider Demographics
NPI:1790012862
Name:MAX-WELLNESS, LLC
Entity Type:Organization
Organization Name:MAX-WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP FINANCE & ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-765-2507
Mailing Address - Street 1:4400 RENAISSANCE PKWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5794
Mailing Address - Country:US
Mailing Address - Phone:216-765-2500
Mailing Address - Fax:216-765-2501
Practice Address - Street 1:30045 DETROIT RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1944
Practice Address - Country:US
Practice Address - Phone:216-765-2500
Practice Address - Fax:216-765-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies