Provider Demographics
NPI:1609577865
Name:WELLS LEGACY HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:WELLS LEGACY HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:321-306-6755
Mailing Address - Street 1:452 OSCEOLA ST STE 106
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-7800
Mailing Address - Country:US
Mailing Address - Phone:321-306-6755
Mailing Address - Fax:321-324-0851
Practice Address - Street 1:452 OSCEOLA ST STE 106
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7800
Practice Address - Country:US
Practice Address - Phone:321-306-6755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty