Provider Demographics
NPI:1942905815
Name:PANAWELL LLC
Entity Type:Organization
Organization Name:PANAWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOZY
Authorized Official - Middle Name:
Authorized Official - Last Name:MSINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-510-6518
Mailing Address - Street 1:15040 SHAMROCK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-6108
Mailing Address - Country:US
Mailing Address - Phone:240-510-6518
Mailing Address - Fax:
Practice Address - Street 1:15040 SHAMROCK RIDGE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-6108
Practice Address - Country:US
Practice Address - Phone:240-510-6518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities