Provider Demographics
NPI:1144894494
Name:ANDROMEDA WELLNESS CENTER INC
Entity type:Organization
Organization Name:ANDROMEDA WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NURA
Authorized Official - Middle Name:MISTY
Authorized Official - Last Name:BUDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-216-4374
Mailing Address - Street 1:6907 UNIVERSITY AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2767
Mailing Address - Country:US
Mailing Address - Phone:608-216-4374
Mailing Address - Fax:608-716-3148
Practice Address - Street 1:582 FARGO TRL
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5667
Practice Address - Country:US
Practice Address - Phone:608-216-4374
Practice Address - Fax:608-716-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty