Provider Demographics
NPI:1851050843
Name:MANNACARE HEALTH AND WELLNESS MEDICAL CENTER
Entity Type:Organization
Organization Name:MANNACARE HEALTH AND WELLNESS MEDICAL CENTER
Other - Org Name:MANNACARE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:AKYEAMPONG
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:740-818-5248
Mailing Address - Street 1:3101 W ELM ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2555
Mailing Address - Country:US
Mailing Address - Phone:419-673-7754
Mailing Address - Fax:419-932-6192
Practice Address - Street 1:3101 W ELM ST STE 300
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2555
Practice Address - Country:US
Practice Address - Phone:419-673-7754
Practice Address - Fax:419-933-2619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-17
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center