Provider Demographics
NPI:1477756146
Name:WELLNESS ENHANCEMENT CENTER LLC
Entity Type:Organization
Organization Name:WELLNESS ENHANCEMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALIE
Authorized Official - Middle Name:NADINE
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:208-964-1717
Mailing Address - Street 1:950 W IRONWOOD DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2644
Mailing Address - Country:US
Mailing Address - Phone:208-964-1717
Mailing Address - Fax:
Practice Address - Street 1:950 W IRONWOOD DR
Practice Address - Street 2:SUITE 2
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2644
Practice Address - Country:US
Practice Address - Phone:208-964-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty