Provider Demographics
NPI:1275291841
Name:CALIFORNIA WELLNESS CENTER INC
Entity Type:Organization
Organization Name:CALIFORNIA WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-379-9237
Mailing Address - Street 1:24842 PYLOS WAY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-4668
Mailing Address - Country:US
Mailing Address - Phone:909-379-9237
Mailing Address - Fax:888-507-7087
Practice Address - Street 1:24842 PYLOS WAY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4668
Practice Address - Country:US
Practice Address - Phone:909-379-9237
Practice Address - Fax:888-507-7087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300411APOtherSUBSTANCE ABUSE TREATMENT