Provider Demographics
NPI:1083769798
Name:COMMUNITY WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:COMMUNITY WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:STECKBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RN
Authorized Official - Phone:208-234-7199
Mailing Address - Street 1:1509 N ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204
Mailing Address - Country:US
Mailing Address - Phone:208-234-7199
Mailing Address - Fax:208-234-8084
Practice Address - Street 1:1509 N ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204
Practice Address - Country:US
Practice Address - Phone:208-234-7199
Practice Address - Fax:208-234-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID000417300251B00000X
ID8053791251J00000X
ID000417100251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health