Provider Demographics
NPI:1649865999
Name:WELLNESS SOCIAL ATTEND CORP
Entity type:Organization
Organization Name:WELLNESS SOCIAL ATTEND CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:ILLANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-356-1853
Mailing Address - Street 1:3480 NE 5TH ST APT 103
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7661
Mailing Address - Country:US
Mailing Address - Phone:305-972-6677
Mailing Address - Fax:
Practice Address - Street 1:15600 SW 288TH ST STE 100A
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1200
Practice Address - Country:US
Practice Address - Phone:305-972-6677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health