Provider Demographics
NPI:1891246658
Name:WELLNESS AMBULATORY CARE INC.
Entity type:Organization
Organization Name:WELLNESS AMBULATORY CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF LICENSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEMECE
Authorized Official - Middle Name:
Authorized Official - Last Name:GASAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LMSQ
Authorized Official - Phone:214-365-6126
Mailing Address - Street 1:5001 SPRING VALLEY RD STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3946
Mailing Address - Country:US
Mailing Address - Phone:214-364-6100
Mailing Address - Fax:214-365-6150
Practice Address - Street 1:6624 CENTRAL AVENUE PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-1400
Practice Address - Country:US
Practice Address - Phone:865-851-9023
Practice Address - Fax:865-951-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
TNI000000019002261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)