Provider Demographics
NPI:1700156304
Name:WELLNESS ADULT DAY SERVICES, INC
Entity Type:Organization
Organization Name:WELLNESS ADULT DAY SERVICES, INC
Other - Org Name:WELLNESS ADULT DAY SERVICES, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VA
Authorized Official - Middle Name:WENDY
Authorized Official - Last Name:XIONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-384-6481
Mailing Address - Street 1:689 DALE ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-1644
Mailing Address - Country:US
Mailing Address - Phone:612-384-6481
Mailing Address - Fax:800-346-9572
Practice Address - Street 1:689 DALE ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1644
Practice Address - Country:US
Practice Address - Phone:612-384-6481
Practice Address - Fax:800-346-9572
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLNESS ADULT DAY SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1059415174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty