Provider Demographics
NPI:1780080861
Name:PROVIDER WELLNESS GROUP, LLC
Entity type:Organization
Organization Name:PROVIDER WELLNESS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SAYED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-613-7622
Mailing Address - Street 1:26105 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-4576
Mailing Address - Country:US
Mailing Address - Phone:248-613-7622
Mailing Address - Fax:248-477-5552
Practice Address - Street 1:26105 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-4576
Practice Address - Country:US
Practice Address - Phone:248-613-7622
Practice Address - Fax:248-477-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care