Provider Demographics
NPI:1023722618
Name:COMMUNITY WELLNESS FOUNDATION LLC
Entity type:Organization
Organization Name:COMMUNITY WELLNESS FOUNDATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRINCESS
Authorized Official - Middle Name:NEZE
Authorized Official - Last Name:AKWURAH-IGWEBUIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:204-297-9646
Mailing Address - Street 1:14504 GREENVIEW DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3290
Mailing Address - Country:US
Mailing Address - Phone:240-297-9646
Mailing Address - Fax:240-297-9310
Practice Address - Street 1:14504 GREENVIEW DR STE 200
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3290
Practice Address - Country:US
Practice Address - Phone:240-297-9646
Practice Address - Fax:240-297-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)