Provider Demographics
NPI:1821520768
Name:ESSENCE CENTER FOR WELL-BEING
Entity Type:Organization
Organization Name:ESSENCE CENTER FOR WELL-BEING
Other - Org Name:ESSE CENTER FOR WELL-BEING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KYSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-982-2400
Mailing Address - Street 1:579 SEQUOIA LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44904-1730
Mailing Address - Country:US
Mailing Address - Phone:419-982-2400
Mailing Address - Fax:
Practice Address - Street 1:2 SMITH AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44905-2855
Practice Address - Country:US
Practice Address - Phone:419-982-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X, 261QM0850X, 261QM0855X, 261QR0405X
OHI.1500096251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder