Provider Demographics
NPI:1790955847
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:903-758-3124
Practice Address - Street 1:602 TITUS ST.
Practice Address - Street 2:STE. 130
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75644-1700
Practice Address - Country:US
Practice Address - Phone:903-758-2610
Practice Address - Fax:903-758-3124
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONGVIEW WELLNESS CENTER INC DBA WELLNESS POINTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183824501Medicaid
TX671933Medicare Oscar/Certification
TX0092BVMedicare PIN