Provider Demographics
NPI:1134866635
Name:WELLNESS LLC
Entity type:Organization
Organization Name:WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NJOROGE
Authorized Official - Last Name:NGINYAYU
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:978-328-7141
Mailing Address - Street 1:PO BOX 376
Mailing Address - Street 2:
Mailing Address - City:WHITE SALMON
Mailing Address - State:WA
Mailing Address - Zip Code:98672-0376
Mailing Address - Country:US
Mailing Address - Phone:509-493-1084
Mailing Address - Fax:509-493-0058
Practice Address - Street 1:460 NE CHERRY ST
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672-1300
Practice Address - Country:US
Practice Address - Phone:509-493-1084
Practice Address - Fax:509-493-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604-748-548OtherUBI
WA2182948Medicaid