Provider Demographics
NPI:1306381900
Name:FAMILY HEALING AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:FAMILY HEALING AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEROLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL-SCAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-502-9294
Mailing Address - Street 1:8081 W. CAPITOL DR.
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8081 W. CAPITOL DR.
Practice Address - Street 2:SUITE 6
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1706
Practice Address - Country:US
Practice Address - Phone:414-367-8793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4999-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1003256132Medicaid