Provider Demographics
NPI:1699580894
Name:ADDICTIVE WELLNESS, LLC
Entity type:Organization
Organization Name:ADDICTIVE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/HOLISTIC HEALTH PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MINICHIELLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN, HHP
Authorized Official - Phone:580-216-9554
Mailing Address - Street 1:9929 COUNTY ROAD 350
Mailing Address - Street 2:
Mailing Address - City:WAYNOKA
Mailing Address - State:OK
Mailing Address - Zip Code:73860-6934
Mailing Address - Country:US
Mailing Address - Phone:580-216-9554
Mailing Address - Fax:
Practice Address - Street 1:1630 SANTA FE ST
Practice Address - Street 2:
Practice Address - City:WAYNOKA
Practice Address - State:OK
Practice Address - Zip Code:73860-3946
Practice Address - Country:US
Practice Address - Phone:580-216-9554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Single Specialty