Provider Demographics
NPI:1134453814
Name:WELLNESS GROUP YOUTH & FAMILY SERVICES, INC.
Entity type:Organization
Organization Name:WELLNESS GROUP YOUTH & FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:REDD
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:804-359-0613
Mailing Address - Street 1:1510 WILLOW LAWN DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3429
Mailing Address - Country:US
Mailing Address - Phone:804-359-0613
Mailing Address - Fax:804-359-0614
Practice Address - Street 1:1510 WILLOW LAWN DR
Practice Address - Street 2:SUITE 10
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3429
Practice Address - Country:US
Practice Address - Phone:804-359-0613
Practice Address - Fax:804-359-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA492-03-003251C00000X, 251E00000X, 251S00000X
VA492-05-001251C00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA492-03-003OtherDEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES
VA492-05-001OtherDEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES