Provider Demographics
NPI:1124808555
Name:WINSTEAD WELLNESS CENTER LLC
Entity type:Organization
Organization Name:WINSTEAD WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WINSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-357-3279
Mailing Address - Street 1:713 ROUND BAY RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3512
Mailing Address - Country:US
Mailing Address - Phone:919-357-3279
Mailing Address - Fax:
Practice Address - Street 1:5215 COLLEY AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-2166
Practice Address - Country:US
Practice Address - Phone:919-357-3279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9147Medicaid