Provider Demographics
NPI:1336393214
Name:THE WELLNESS CENTER
Entity Type:Organization
Organization Name:THE WELLNESS CENTER
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CASE MANGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHONTEL
Authorized Official - Middle Name:LARISE
Authorized Official - Last Name:ROLISON
Authorized Official - Suffix:I
Authorized Official - Credentials:CERTIFICATE
Authorized Official - Phone:323-602-9782
Mailing Address - Street 1:7126 SOMERSET BLVD
Mailing Address - Street 2:PARMOUNT CA 90723
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-3979
Mailing Address - Country:US
Mailing Address - Phone:323-602-9782
Mailing Address - Fax:
Practice Address - Street 1:7126 SOMERSET BLVD
Practice Address - Street 2:PARMOUNT CA 90723
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-3979
Practice Address - Country:US
Practice Address - Phone:323-602-9782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE VILLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251B00000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management