Provider Demographics
NPI:1740040591
Name:WELLNESS RE-ENTRY
Entity type:Organization
Organization Name:WELLNESS RE-ENTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-763-2535
Mailing Address - Street 1:3600 N DUKE ST. STE. 1
Mailing Address - Street 2:#1155
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704
Mailing Address - Country:US
Mailing Address - Phone:919-590-5508
Mailing Address - Fax:919-287-2934
Practice Address - Street 1:1101 N MANGUM ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-1931
Practice Address - Country:US
Practice Address - Phone:919-590-5508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:4EVERMORE VENTURES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-20
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management