MEDICARE: WAKE UP WELL RECOVERY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1265923775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAKE UP WELL RECOVERY LLC

Provider Business Mailing Address
First Line	:	211 DONELSON PIKE STE 108
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37214-2929
Country	:	US
Telephone Number	:	629-203-8199
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 DONELSON PIKE STE 108
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37214-2929
Country	:	US
Telephone Number	:	629-203-8199
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	WILLIAM WYSONG
Credential	:
Telephone Number	:	615-482-0488

Provider Enumeration Date	:	05/21/2018
Last Update Date	:	05/21/2018

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