Provider Demographics
NPI:1679885099
Name:WELLNESS INSTITUTE FOR COMMUNITY LIVING
Entity Type:Organization
Organization Name:WELLNESS INSTITUTE FOR COMMUNITY LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-438-9517
Mailing Address - Street 1:26 MALONES WAY
Mailing Address - Street 2:
Mailing Address - City:KITTRELL
Mailing Address - State:NC
Mailing Address - Zip Code:27544-9159
Mailing Address - Country:US
Mailing Address - Phone:252-438-9517
Mailing Address - Fax:919-496-2906
Practice Address - Street 1:26 MALONES WAY
Practice Address - Street 2:
Practice Address - City:KITTRELL
Practice Address - State:NC
Practice Address - Zip Code:27544-9159
Practice Address - Country:US
Practice Address - Phone:252-438-9517
Practice Address - Fax:919-496-2906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral Health
No347C00000XTransportation ServicesPrivate Vehicle