Provider Demographics
NPI:1790928539
Name:NETWORK OF WELLNESS, LLC
Entity Type:Organization
Organization Name:NETWORK OF WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KACZENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-221-7238
Mailing Address - Street 1:801 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-4613
Mailing Address - Country:US
Mailing Address - Phone:501-221-7238
Mailing Address - Fax:501-221-7239
Practice Address - Street 1:801 SCOTT ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-4613
Practice Address - Country:US
Practice Address - Phone:501-221-7238
Practice Address - Fax:501-221-7239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health