Provider Demographics
NPI:1831576446
Name:RESILIENCE ANTI-AGING & INTERNAL MEDICINE WELLNESS CLINIC INC
Entity type:Organization
Organization Name:RESILIENCE ANTI-AGING & INTERNAL MEDICINE WELLNESS CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:MR
Authorized Official - First Name:DONAVON
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER TRAINER
Authorized Official - Phone:216-261-3698
Mailing Address - Street 1:25701 N LAKELAND BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-2450
Mailing Address - Country:US
Mailing Address - Phone:216-261-6398
Mailing Address - Fax:440-525-5564
Practice Address - Street 1:25701 N LAKELAND BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-2450
Practice Address - Country:US
Practice Address - Phone:216-261-6398
Practice Address - Fax:440-525-5564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty