Provider Demographics
NPI:1811648678
Name:ROAD2WELLNESS PLLC
Entity type:Organization
Organization Name:ROAD2WELLNESS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEDECKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-780-2185
Mailing Address - Street 1:616 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-8645
Mailing Address - Country:US
Mailing Address - Phone:810-936-0079
Mailing Address - Fax:810-936-0079
Practice Address - Street 1:616 W BROAD ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:MI
Practice Address - Zip Code:48451-8645
Practice Address - Country:US
Practice Address - Phone:810-936-0079
Practice Address - Fax:810-936-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty