Provider Demographics
NPI:1932976362
Name:ADULT WELLNESS CLINIC LLC
Entity Type:Organization
Organization Name:ADULT WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:ALANA
Authorized Official - Last Name:LITVAK
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:440-781-5200
Mailing Address - Street 1:23850 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5829
Mailing Address - Country:US
Mailing Address - Phone:440-781-5200
Mailing Address - Fax:216-508-4058
Practice Address - Street 1:23850 COMMERCE PARK STE C
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5829
Practice Address - Country:US
Practice Address - Phone:440-781-5200
Practice Address - Fax:216-508-4058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)