Provider Demographics
NPI:1609409762
Name:DEFINING WELLNESS CENTERS , LLC
Entity type:Organization
Organization Name:DEFINING WELLNESS CENTERS , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAYAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-725-3748
Mailing Address - Street 1:3949 HIGHWAY 43 N
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7240
Mailing Address - Country:US
Mailing Address - Phone:717-814-1970
Mailing Address - Fax:
Practice Address - Street 1:3949 HIGHWAY 43 N
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-7240
Practice Address - Country:US
Practice Address - Phone:769-241-2601
Practice Address - Fax:769-241-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1861047250OtherNPI