Basic Information
| Provider Information | |||||||||
| NPI: | 1811413289 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WASHINGTON TOWNSHIP WELLNESS CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8244 E US HIGHWAY 36 STE 1100 | ||||||||
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| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461239627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172723688 | ||||||||
| FaxNumber: | 3172727515 | ||||||||
| Practice Location | |||||||||
| Address1: | 7203 E US HIGHWAY 36 | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461237967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175446135 | ||||||||
| FaxNumber: | 3175446139 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2017 | ||||||||
| LastUpdateDate: | 08/17/2017 | ||||||||
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| AuthorizedOfficialLastName: | SMALLWOOD | ||||||||
| AuthorizedOfficialFirstName: | MARIJANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3172723688 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HENDRICKS COMMUNITY HOSPITAL | ||||||||
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| AuthorizedOfficialCredential: | MSN, RN, NE-BC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1800X | Y | Ambulatory Health Care Facilities | Clinic/Center | Corporate Health |
No ID Information.