Provider Demographics
NPI:1346789294
Name:BAYVIEW WELLNESS CLINIC
Entity type:Organization
Organization Name:BAYVIEW WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LINUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ANUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-356-3400
Mailing Address - Street 1:206 BURWASH AVE
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-9510
Mailing Address - Country:US
Mailing Address - Phone:217-356-3400
Mailing Address - Fax:217-866-0122
Practice Address - Street 1:206 BURWASH AVE
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9510
Practice Address - Country:US
Practice Address - Phone:217-356-3400
Practice Address - Fax:217-866-0122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAYVIEW FAMILY CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL31023101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty