Provider Demographics
NPI:1245065903
Name:ROA WELLNESS LLC
Entity type:Organization
Organization Name:ROA WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-250-8989
Mailing Address - Street 1:151 KALMUS DR STE A203
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5999
Mailing Address - Country:US
Mailing Address - Phone:402-250-8989
Mailing Address - Fax:714-475-2746
Practice Address - Street 1:10452 CIRCULO DE VILLA
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3671
Practice Address - Country:US
Practice Address - Phone:402-250-8989
Practice Address - Fax:714-475-2746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility