Provider Demographics
NPI:1285879577
Name:THE WELLNESS CENTER OF WEST TN INC
Entity type:Organization
Organization Name:THE WELLNESS CENTER OF WEST TN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-612-8869
Mailing Address - Street 1:171 TUCKER STREET
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063
Mailing Address - Country:US
Mailing Address - Phone:731-612-8869
Mailing Address - Fax:731-221-8801
Practice Address - Street 1:171 TUCKER STREET
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063
Practice Address - Country:US
Practice Address - Phone:731-612-8869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10000000034453747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty