Provider Demographics
NPI:1245841352
Name:LWELL LLC
Entity type:Organization
Organization Name:LWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORNSHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-585-3441
Mailing Address - Street 1:1309 JAMESTOWN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3380
Mailing Address - Country:US
Mailing Address - Phone:757-585-3441
Mailing Address - Fax:
Practice Address - Street 1:1309 JAMESTOWN RD STE 102
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3380
Practice Address - Country:US
Practice Address - Phone:757-585-3441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LWELL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty