Provider Demographics
NPI:1174790174
Name:GILEAD WELLNESS NETWORK INC
Entity type:Organization
Organization Name:GILEAD WELLNESS NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CYRIL
Authorized Official - Middle Name:C
Authorized Official - Last Name:NWAGURU
Authorized Official - Suffix:
Authorized Official - Credentials:MA MSW LMSW CSW
Authorized Official - Phone:248-968-8556
Mailing Address - Street 1:11000 W MCNICHOLS RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2357
Mailing Address - Country:US
Mailing Address - Phone:248-688-5004
Mailing Address - Fax:248-968-5939
Practice Address - Street 1:11000 W MCNICHOLS RD
Practice Address - Street 2:SUITE 312
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2357
Practice Address - Country:US
Practice Address - Phone:248-688-5004
Practice Address - Fax:248-968-5939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management