Provider Demographics
NPI:1356186787
Name:ADVANCED HEALTH CARE AND WELLNESS LLC
Entity type:Organization
Organization Name:ADVANCED HEALTH CARE AND WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-977-1489
Mailing Address - Street 1:100 CONSTITUTION DR STE 217
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6799
Mailing Address - Country:US
Mailing Address - Phone:559-977-1489
Mailing Address - Fax:559-272-0308
Practice Address - Street 1:100 CONSTITUTION DR STE 217
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6799
Practice Address - Country:US
Practice Address - Phone:757-963-7729
Practice Address - Fax:757-470-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-27
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty