Provider Demographics
NPI:1447863121
Name:EXCEPTIONAL WELLNESS REHABILITATION CENTER INCORPORATED
Entity type:Organization
Organization Name:EXCEPTIONAL WELLNESS REHABILITATION CENTER INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-845-1304
Mailing Address - Street 1:2440 TEXAS PKWY STE 335
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-4098
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2440 TEXAS PKWY STE 335
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-4098
Practice Address - Country:US
Practice Address - Phone:281-845-1304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit