Provider Demographics
NPI:1922554401
Name:PREMIER WELLNESS HEALTHCARE
Entity Type:Organization
Organization Name:PREMIER WELLNESS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-459-7447
Mailing Address - Street 1:133 BLACK OAK TRL
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:PA
Mailing Address - Zip Code:17314-8756
Mailing Address - Country:US
Mailing Address - Phone:888-653-3933
Mailing Address - Fax:888-653-0154
Practice Address - Street 1:7 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FAWN GROVE
Practice Address - State:PA
Practice Address - Zip Code:17321-9506
Practice Address - Country:US
Practice Address - Phone:888-333-1345
Practice Address - Fax:888-653-0154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty