Provider Demographics
NPI:1205449782
Name:SUMMIT HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:SUMMIT HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-850-1649
Mailing Address - Street 1:6200 WOODLAND AVE
Mailing Address - Street 2:62ND WOODLAND AVE. WOODLAND VILLAGE SHOPPING CENTER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142
Mailing Address - Country:US
Mailing Address - Phone:215-850-1649
Mailing Address - Fax:
Practice Address - Street 1:6200 WOODLAND AVE
Practice Address - Street 2:62ND WOODLAND AVE. WOODLAND VILLAGE SHOPPING CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142
Practice Address - Country:US
Practice Address - Phone:215-850-1649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)