Provider Demographics
NPI:1609581727
Name:ARK WELLNESS CENTER
Entity Type:Organization
Organization Name:ARK WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:NYLA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:513-212-9965
Mailing Address - Street 1:7370 KINGSGATE WAY STE E
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2486
Mailing Address - Country:US
Mailing Address - Phone:513-823-4146
Mailing Address - Fax:513-743-7570
Practice Address - Street 1:7370 KINGSGATE WAY STE E
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2486
Practice Address - Country:US
Practice Address - Phone:513-823-4146
Practice Address - Fax:513-743-7570
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARK WELLNESS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01-8862OtherBEHAVIORAL HEALTH CERTIFICATION