| The River Wellness Llc | |
|
245 Katherine Dr Ste D Flowood MS 39232-9588 | |
| (888) 402-0840 | |
| Not Available |
| Full Name | The River Wellness Llc |
|---|---|
| Speciality | Social Worker |
| Location | 245 Katherine Dr Ste D, Flowood, Mississippi |
| Authorized Official Name and Position | Patricia Ruth Cruz (OWNER) |
| Authorized Official Contact | 8032606520 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The River Wellness Llc Po Box 321383 Flowood MS 39232-1383 Ph: (888) 402-0840 | The River Wellness Llc 245 Katherine Dr Ste D Flowood MS 39232-9588 Ph: (888) 402-0840 |
| NPI Number | 1730709478 |
|---|---|
| Provider Enumeration Date | 04/23/2020 |
| Last Update Date | 12/21/2021 |
| Certification Date | 12/21/2021 |
| Medicare PECOS PAC ID | 7719308576 |
|---|---|
| Medicare Enrollment ID | O20200602003015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730709478 | NPI | - | NPPES |
| 01983101 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Patricia Ruth Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366865750 PECOS PAC ID: 8628499480 Enrollment ID: I20200602003085 |
| Provider Name | Kimberly M Horton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750840575 PECOS PAC ID: 1052798766 Enrollment ID: I20220519000032 |
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