Provider Demographics
NPI:1811153919
Name:PERSONALIZED WELLNESS CENTER
Entity type:Organization
Organization Name:PERSONALIZED WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CARGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-633-7273
Mailing Address - Street 1:1653 MERRIMAN RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-5210
Mailing Address - Country:US
Mailing Address - Phone:330-867-3230
Mailing Address - Fax:330-867-1928
Practice Address - Street 1:1653 MERRIMAN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-5210
Practice Address - Country:US
Practice Address - Phone:330-867-3230
Practice Address - Fax:330-867-1928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty