Provider Demographics
NPI:1043688138
Name:BWELL4EVER, LLC
Entity type:Organization
Organization Name:BWELL4EVER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEREN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:423-531-9355
Mailing Address - Street 1:7476 NASHVILLE ST
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-2358
Mailing Address - Country:US
Mailing Address - Phone:706-935-3055
Mailing Address - Fax:706-935-3056
Practice Address - Street 1:1447 VANCE RD STE 106
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3665
Practice Address - Country:US
Practice Address - Phone:423-531-9355
Practice Address - Fax:423-531-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA621999163WC1500X
261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty