Provider Demographics
NPI:1841153608
Name:DES MOINES WELLNESS CENTER
Entity type:Organization
Organization Name:DES MOINES WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:PETRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-440-3200
Mailing Address - Street 1:621 NW 53RD ST STE 370
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-8241
Mailing Address - Country:US
Mailing Address - Phone:978-440-3200
Mailing Address - Fax:323-529-8134
Practice Address - Street 1:5820 WINWOOD DR
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1821
Practice Address - Country:US
Practice Address - Phone:978-440-3200
Practice Address - Fax:323-529-8134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-08
Last Update Date:2025-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility