Provider Demographics
NPI:1497995369
Name:ABEL WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:ABEL WELLNESS CENTER, LLC
Other - Org Name:ABEL WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:F
Authorized Official - Last Name:PORTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-205-3085
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-1300
Mailing Address - Country:US
Mailing Address - Phone:360-205-3085
Mailing Address - Fax:360-275-2007
Practice Address - Street 1:24160 NE STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-9626
Practice Address - Country:US
Practice Address - Phone:360-205-3085
Practice Address - Fax:360-275-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023492171100000X, 225700000X
WANT00001625175F00000X
WANT60061445175F00000X
WAMA00024197225700000X
WAMA00022576225700000X
WAMA00025399225700000X
WAMA00022443225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty