Provider Demographics
NPI:1437891736
Name:HIGHER GROUND WELLNESS
Entity Type:Organization
Organization Name:HIGHER GROUND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:740-562-6500
Mailing Address - Street 1:514 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-6886
Mailing Address - Country:US
Mailing Address - Phone:740-562-6500
Mailing Address - Fax:
Practice Address - Street 1:1616 W CHURCH ST STE A
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1540
Practice Address - Country:US
Practice Address - Phone:740-562-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1437667755Medicaid