Provider Demographics
NPI:1043789662
Name:GUIDEWELL, INC.
Entity type:Organization
Organization Name:GUIDEWELL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIABETES PREVENTION PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:800-477-3736
Mailing Address - Street 1:4800 DEERWOOD CAMPUS PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-6498
Mailing Address - Country:US
Mailing Address - Phone:904-905-8618
Mailing Address - Fax:904-997-5211
Practice Address - Street 1:4855 TOWN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-8437
Practice Address - Country:US
Practice Address - Phone:904-905-8618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency