Provider Demographics
NPI:1205349198
Name:WELLNESS WAY INC
Entity type:Organization
Organization Name:WELLNESS WAY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAESTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-722-2208
Mailing Address - Street 1:1385 S COLORADO BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3315
Mailing Address - Country:US
Mailing Address - Phone:303-722-2208
Mailing Address - Fax:303-722-4411
Practice Address - Street 1:1385 S COLORADO BLVD STE 306
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3315
Practice Address - Country:US
Practice Address - Phone:303-722-2208
Practice Address - Fax:303-722-4411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLNESS WAY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1004L0251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17822050Medicaid