Provider Demographics
NPI:1154975449
Name:THE WELLNESS LOFT, LLC
Entity type:Organization
Organization Name:THE WELLNESS LOFT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNO
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:SHERRON
Authorized Official - Last Name:WOODY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:443-414-4412
Mailing Address - Street 1:13960 HILLCROFT ST APT 1014
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77085-1514
Mailing Address - Country:US
Mailing Address - Phone:443-414-4412
Mailing Address - Fax:
Practice Address - Street 1:13960 HILLCROFT ST APT 1014
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77085-1514
Practice Address - Country:US
Practice Address - Phone:443-414-4412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health