Provider Demographics
NPI:1891027850
Name:WELLNESS RESTORATION CENTERS OF MISSOURI
Entity Type:Organization
Organization Name:WELLNESS RESTORATION CENTERS OF MISSOURI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDEE
Authorized Official - Middle Name:P
Authorized Official - Last Name:VAN NESS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:719-651-5102
Mailing Address - Street 1:6060 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-4762
Mailing Address - Country:US
Mailing Address - Phone:314-846-8800
Mailing Address - Fax:314-846-8840
Practice Address - Street 1:6060 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-4762
Practice Address - Country:US
Practice Address - Phone:314-846-8840
Practice Address - Fax:314-846-8840
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VAN NESS ENTREPRISES, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty