Provider Demographics
NPI:1013407741
Name:THE CENTER HEALTH & WELLNESS
Entity Type:Organization
Organization Name:THE CENTER HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:LACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:501-712-4333
Mailing Address - Street 1:3801 JFK BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-8247
Mailing Address - Country:US
Mailing Address - Phone:501-712-4333
Mailing Address - Fax:501-712-4333
Practice Address - Street 1:3801 JFK BLVD STE C
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-8247
Practice Address - Country:US
Practice Address - Phone:501-712-4333
Practice Address - Fax:501-712-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center