Provider Demographics
NPI:1942608682
Name:SWEETLIFE DIABETES HEALTH CENTERS
Entity type:Organization
Organization Name:SWEETLIFE DIABETES HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOWLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-743-2442
Mailing Address - Street 1:34B TROLLEY SQ
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-3352
Mailing Address - Country:US
Mailing Address - Phone:302-235-3518
Mailing Address - Fax:
Practice Address - Street 1:34B TROLLEY SQ
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-3352
Practice Address - Country:US
Practice Address - Phone:302-235-3518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty