MEDICARE: RIGHT WAY WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
2	324500000X	Substance Abuse Rehabilitation Facility
3	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

General Provider Information

NPI Number	:	1568028751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIGHT WAY WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	1225 E RIVER DR
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33063-3635
Country	:	US
Telephone Number	:	954-805-0177
Fax Number	:	888-293-5884

Provider Business Practice Location Address
First Line	:	4757 W MONTROSE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1504
Country	:	US
Telephone Number	:	954-805-0177
Fax Number	:	888-293-5884

Authorized Official
Title or Position	:	CEO
Name	:	MS. VAN JONES
Credential	:	MS, EDD, MCAP
Telephone Number	:	954-805-0177

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	05/14/2019

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