Provider Demographics
NPI:1275008195
Name:WELLNESS CENTER OF OXFORD
Entity Type:Organization
Organization Name:WELLNESS CENTER OF OXFORD
Other - Org Name:WELLNESS CENTER OF OXFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:120-395-1185
Mailing Address - Street 1:350 CENTER ROCK GRN STE 9
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-3170
Mailing Address - Country:US
Mailing Address - Phone:203-951-1858
Mailing Address - Fax:203-307-1771
Practice Address - Street 1:350 CENTER ROCK GRN STE 9
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-3170
Practice Address - Country:US
Practice Address - Phone:203-951-1858
Practice Address - Fax:203-307-1771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-07
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT8084662Medicaid