Provider Demographics
NPI:1679931539
Name:THE WELLNESS CENTER CENTRAL
Entity Type:Organization
Organization Name:THE WELLNESS CENTER CENTRAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEER SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:AMED
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:PRADO
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:714-361-4860
Mailing Address - Street 1:401 S TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2550
Mailing Address - Country:US
Mailing Address - Phone:714-361-4860
Mailing Address - Fax:
Practice Address - Street 1:401 S TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2550
Practice Address - Country:US
Practice Address - Phone:714-361-4860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOLINA HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health