| Beloved Wellness Center, Llc | |
|
3535 30th Ave Ste 207 Kenosha WI 53144-1632 | |
| (262) 496-8897 | |
| Not Available |
| Full Name | Beloved Wellness Center, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3535 30th Ave Ste 207, Kenosha, Wisconsin |
| Authorized Official Name and Position | Dominique Pritchett (OWNER/DIRECTOR) |
| Authorized Official Contact | 2624968897 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Beloved Wellness Center, Llc 3535 30th Ave Ste 207 Kenosha WI 53144-1632 Ph: (262) 496-8897 | Beloved Wellness Center, Llc 3535 30th Ave Ste 207 Kenosha WI 53144-1632 Ph: (262) 496-8897 |
| NPI Number | 1881228559 |
|---|---|
| Provider Enumeration Date | 03/02/2020 |
| Last Update Date | 03/16/2020 |
| Certification Date | 03/16/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881228559 | NPI | - | NPPES |
| 1356605323 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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