Provider Demographics
NPI:1932843992
Name:CENTER FOR WELLNESS CLINIC LLC
Entity Type:Organization
Organization Name:CENTER FOR WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRI
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-554-0280
Mailing Address - Street 1:5258 LINTON BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6564
Mailing Address - Country:US
Mailing Address - Phone:561-292-3436
Mailing Address - Fax:561-292-3479
Practice Address - Street 1:5258 LINTON BLVD STE 105
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6564
Practice Address - Country:US
Practice Address - Phone:561-292-3436
Practice Address - Fax:561-292-3479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty