| Organization Name: | WELLNESS RESIDENTIAL SERVICES |
| NPI Number: | 1104256221 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | IDORENYIN UDO FRED (DIRECTOR) |
| Mailing Address: | 5174 Oak Creek Trail Liberty Township Liberty Township |
| State: | OH US |
| Postal Code: | 45011 |
| Phone Number: | 5139694160 |
| Fax Number: | 5137370018 |
| NPI Enumeration Date: | 11/27/2013 |
| NPI Last Update Date: | 11/27/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SH0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Home Health |
| Taxonomy Definition: | |