Provider Demographics
NPI:1871865527
Name:SOUTHERN WELLNESS CENTER
Entity Type:Organization
Organization Name:SOUTHERN WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-798-0684
Mailing Address - Street 1:320 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27855-1417
Mailing Address - Country:US
Mailing Address - Phone:919-798-0684
Mailing Address - Fax:919-301-8996
Practice Address - Street 1:3434 IDLEWOOD VILLAGE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-6090
Practice Address - Country:US
Practice Address - Phone:919-798-0684
Practice Address - Fax:919-301-8996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTECH SERVICE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health