Provider Demographics
NPI:1649821158
Name:MANNACARE HEALTH AND WELLNESS MEDICAL CENTER LLC
Entity type:Organization
Organization Name:MANNACARE HEALTH AND WELLNESS MEDICAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:AKYEAMPONG
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:419-673-7754
Mailing Address - Street 1:3101 W ELM ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2555
Mailing Address - Country:US
Mailing Address - Phone:419-673-7754
Mailing Address - Fax:
Practice Address - Street 1:3101 W ELM ST STE 300
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2555
Practice Address - Country:US
Practice Address - Phone:419-673-7754
Practice Address - Fax:419-458-2165
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANNACARE HEALTH AND WELLNESS MEDICAL CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-25
Last Update Date:2023-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty