Provider Demographics
NPI:1881306439
Name:TIME WELLNESS LLC
Entity type:Organization
Organization Name:TIME WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOO
Authorized Official - Prefix:
Authorized Official - First Name:DANEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:FESEFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-654-2350
Mailing Address - Street 1:1160 HAMMOND DR UNIT 409
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5498
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39 STEVENS HOLLOW RD
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:TN
Practice Address - Zip Code:38488-5269
Practice Address - Country:US
Practice Address - Phone:423-413-6195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities