Provider Demographics
NPI: | 1033685953 |
---|---|
Name: | WELLNESS HEALTH SERVICES, LLC |
Entity Type: | Organization |
Organization Name: | WELLNESS HEALTH SERVICES, LLC |
Other - Org Name: | THE ARK OF DC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | NADINE |
Authorized Official - Middle Name: | ARNAL |
Authorized Official - Last Name: | TOKO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 770-331-7912 |
Mailing Address - Street 1: | 11202 MARWOOD HILL DR |
Mailing Address - Street 2: | |
Mailing Address - City: | POTOMAC |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 20854-1241 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 770-331-7912 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1818 NEW YORK AVE NE STE 110 |
Practice Address - Street 2: | |
Practice Address - City: | WASHINGTON |
Practice Address - State: | DC |
Practice Address - Zip Code: | 20002-1849 |
Practice Address - Country: | US |
Practice Address - Phone: | 202-489-0615 |
Practice Address - Fax: | 202-379-9220 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-10-18 |
Last Update Date: | 2024-02-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
No | 251E00000X | Agencies | Home Health | Group - Multi-Specialty | |
No | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | Group - Multi-Specialty |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
No | 261QM2800X | Ambulatory Health Care Facilities | Clinic/Center | Methadone | |
No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | |
No | 291U00000X | Laboratories | Clinical Medical Laboratory | Group - Multi-Specialty | |
No | 3245S0500X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
DC | 063172881 | Medicaid |