Provider Demographics
NPI:1093441149
Name:OUR FAMILY WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:OUR FAMILY WELLNESS CENTER, LLC
Other - Org Name:OUR FAMILY WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LONDOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-802-2797
Mailing Address - Street 1:2646 S LOOP W STE 360
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2688
Mailing Address - Country:US
Mailing Address - Phone:346-802-2797
Mailing Address - Fax:281-501-2063
Practice Address - Street 1:2646 S LOOP W STE 360
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2688
Practice Address - Country:US
Practice Address - Phone:346-802-2797
Practice Address - Fax:281-501-2063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)