Provider Demographics
NPI:1841818457
Name:WELLNESS FOUNDATION
Entity type:Organization
Organization Name:WELLNESS FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-608-2461
Mailing Address - Street 1:9850 S MARYLAND PKWY # 5-371
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7146
Mailing Address - Country:US
Mailing Address - Phone:702-517-7914
Mailing Address - Fax:
Practice Address - Street 1:104 RIVERWALK WAY
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-9321
Practice Address - Country:US
Practice Address - Phone:803-608-2461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)