Provider Demographics
NPI:1992388052
Name:UTOPIA WELLCARE LLC
Entity Type:Organization
Organization Name:UTOPIA WELLCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-331-2882
Mailing Address - Street 1:460 SYCAMORE MILLS RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2032
Mailing Address - Country:US
Mailing Address - Phone:610-331-8822
Mailing Address - Fax:610-595-0323
Practice Address - Street 1:460 SYCAMORE MILLS RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2032
Practice Address - Country:US
Practice Address - Phone:610-331-8822
Practice Address - Fax:610-595-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty