Organization Name: | LONGVIEW WELLNESS CENTER, INC |
NPI Number: | 1790955847 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TIMOTHY CHAD JONES (CEO) |
Mailing Address: | 602 Titus St. Ste. 130 Gilmer |
State: | TX US |
Postal Code: | 756441700 |
Phone Number: | 9037582610 |
Fax Number: | 9037583124 |
NPI Enumeration Date: | 03/05/2008 |
NPI Last Update Date: | 08/05/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |