Provider Demographics
NPI:1578170486
Name:CONTINUIM WELLNESS, LLC.
Entity Type:Organization
Organization Name:CONTINUIM WELLNESS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:L,AC
Authorized Official - Phone:219-689-5563
Mailing Address - Street 1:14785 W 101ST AVE # 101
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-3371
Mailing Address - Country:US
Mailing Address - Phone:219-689-5563
Mailing Address - Fax:219-979-5253
Practice Address - Street 1:14785 W 101ST AVE # 101
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-3371
Practice Address - Country:US
Practice Address - Phone:219-689-5563
Practice Address - Fax:219-979-5253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty