Provider Demographics
NPI:1881266989
Name:BN WELLNESS GROUP
Entity type:Organization
Organization Name:BN WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHAL
Authorized Official - Suffix:
Authorized Official - Credentials:LICDC, LMSW
Authorized Official - Phone:216-273-3901
Mailing Address - Street 1:2460 FAIRMOUNT BLVD STE 326
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3197
Mailing Address - Country:US
Mailing Address - Phone:216-273-3901
Mailing Address - Fax:
Practice Address - Street 1:2460 FAIRMOUNT BLVD STE 326
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3197
Practice Address - Country:US
Practice Address - Phone:216-273-3901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0399620Medicaid