Provider Demographics
NPI:1376241745
Name:360 WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:360 WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LICDC
Authorized Official - Phone:937-668-6633
Mailing Address - Street 1:3008 SUDBURY DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1129
Mailing Address - Country:US
Mailing Address - Phone:937-310-1269
Mailing Address - Fax:855-631-4272
Practice Address - Street 1:3008 SUDBURY DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-1129
Practice Address - Country:US
Practice Address - Phone:937-310-1269
Practice Address - Fax:855-631-4272
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:360 WELLNESS CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty