Provider Demographics
NPI:1992020416
Name:DARWIN'S HEALTH CLUB, INC
Entity Type:Organization
Organization Name:DARWIN'S HEALTH CLUB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-679-1591
Mailing Address - Street 1:47-53 WATER STREET
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063
Mailing Address - Country:US
Mailing Address - Phone:716-679-1591
Mailing Address - Fax:716-679-1592
Practice Address - Street 1:47-53 WATER STREET
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063
Practice Address - Country:US
Practice Address - Phone:716-679-1591
Practice Address - Fax:716-679-1592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management