Provider Demographics
NPI:1700344611
Name:GEORGE WOLFE JR., LLC
Entity Type:Organization
Organization Name:GEORGE WOLFE JR., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:JR
Authorized Official - Credentials:CNP
Authorized Official - Phone:330-388-0339
Mailing Address - Street 1:PO BOX 67071
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44222-7071
Mailing Address - Country:US
Mailing Address - Phone:330-388-0339
Mailing Address - Fax:234-284-8364
Practice Address - Street 1:330 BROADWAY ST E STE E
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3312
Practice Address - Country:US
Practice Address - Phone:330-388-0339
Practice Address - Fax:234-284-8364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-10
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation