Healthcare Provider Details

I. General information

NPI: 1568028751
Provider Name (Legal Business Name): RIGHT WAY WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4757 W MONTROSE AVE
CHICAGO IL
60641-1504
US

IV. Provider business mailing address

1225 E RIVER DR
MARGATE FL
33063-3635
US

V. Phone/Fax

Practice location:
  • Phone: 954-805-0177
  • Fax: 888-293-5884
Mailing address:
  • Phone: 954-805-0177
  • Fax: 888-293-5884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. VAN JONES
Title or Position: CEO
Credential: MS, EDD, MCAP
Phone: 954-805-0177