Provider Demographics
NPI:1881254175
Name:VIRA WELLNESS CENTER LLC
Entity type:Organization
Organization Name:VIRA WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VANESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:JONEAS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, EDD, CRRA, MCAP
Authorized Official - Phone:954-805-0177
Mailing Address - Street 1:1845 N LARRABEE ST APT 204
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5246
Mailing Address - Country:US
Mailing Address - Phone:773-437-0731
Mailing Address - Fax:
Practice Address - Street 1:1845 N LARRABEE ST APT 204
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5246
Practice Address - Country:US
Practice Address - Phone:773-437-0731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health