Provider Demographics
NPI:1508615451
Name:OPTWELL HEALTH SERVICES
Entity type:Organization
Organization Name:OPTWELL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-304-4767
Mailing Address - Street 1:233 WASHINGTON TER
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08106-1627
Mailing Address - Country:US
Mailing Address - Phone:856-304-4767
Mailing Address - Fax:
Practice Address - Street 1:2 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1294
Practice Address - Country:US
Practice Address - Phone:856-304-4767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty