Provider Demographics
NPI:1356104541
Name:MOLLEY FAMILY HEALTHCARE & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:MOLLEY FAMILY HEALTHCARE & WELLNESS CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANSU
Authorized Official - Middle Name:SIRYON
Authorized Official - Last Name:MOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:610-944-4290
Mailing Address - Street 1:649 SOUTH AVE UNIT 7
Mailing Address - Street 2:
Mailing Address - City:SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-3541
Mailing Address - Country:US
Mailing Address - Phone:610-944-4290
Mailing Address - Fax:
Practice Address - Street 1:649 SOUTH AVE UNIT 7
Practice Address - Street 2:
Practice Address - City:SECANE
Practice Address - State:PA
Practice Address - Zip Code:19018-3541
Practice Address - Country:US
Practice Address - Phone:610-944-4290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty