Provider Demographics
NPI: | 1710515630 |
---|---|
Name: | LONGVIEW WELLNESS CENTER, INC. |
Entity Type: | Organization |
Organization Name: | LONGVIEW WELLNESS CENTER, INC. |
Other - Org Name: | WELLNESS POINTE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TIMOTHY |
Authorized Official - Middle Name: | CHAD |
Authorized Official - Last Name: | JONES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 903-758-2610 |
Mailing Address - Street 1: | 1107 E MARSHALL AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | LONGVIEW |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75601-5602 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 903-758-2610 |
Mailing Address - Fax: | 903-758-7081 |
Practice Address - Street 1: | 1901 MULBERRY AVE STE A |
Practice Address - Street 2: | |
Practice Address - City: | MOUNT PLEASANT |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75455-2369 |
Practice Address - Country: | US |
Practice Address - Phone: | 903-758-2610 |
Practice Address - Fax: | 903-758-7081 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-03-27 |
Last Update Date: | 2024-01-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |