Healthcare Provider Details

I. General information

NPI: 1629654140
Provider Name (Legal Business Name): 360-WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3008 SUDBURY DR
KETTERING OH
45420-1129
US

IV. Provider business mailing address

2413 BARNETT DR
BELLBROOK OH
45305-1705
US

V. Phone/Fax

Practice location:
  • Phone: 937-310-1269
  • Fax: 937-310-1199
Mailing address:
  • Phone: 937-668-6633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY A BROWN JR.
Title or Position: OWNER
Credential: LICDC
Phone: 937-668-6633