Provider Demographics
NPI:1457940793
Name:DEEP WELL HEALTH CARE LLC
Entity Type:Organization
Organization Name:DEEP WELL HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-422-3194
Mailing Address - Street 1:419 CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2504
Mailing Address - Country:US
Mailing Address - Phone:215-422-3194
Mailing Address - Fax:215-422-3148
Practice Address - Street 1:7848 OLD YORK RD STE 200A
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2541
Practice Address - Country:US
Practice Address - Phone:215-422-3130
Practice Address - Fax:215-422-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty