Provider Demographics
NPI:1699167239
Name:COMMUNITY WELLNESS CENTER
Entity type:Organization
Organization Name:COMMUNITY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLACOV
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-351-8427
Mailing Address - Street 1:1995 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4604
Mailing Address - Country:US
Mailing Address - Phone:503-351-8427
Mailing Address - Fax:503-406-2294
Practice Address - Street 1:1995 8TH AVE
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4604
Practice Address - Country:US
Practice Address - Phone:503-351-8427
Practice Address - Fax:503-406-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3857261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty