Healthcare Provider Details

I. General information

NPI: 1609581727
Provider Name (Legal Business Name): ARK WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7370 KINGSGATE WAY STE E
WEST CHESTER OH
45069-2486
US

IV. Provider business mailing address

7370 KINGSGATE WAY STE E
WEST CHESTER OH
45069-2486
US

V. Phone/Fax

Practice location:
  • Phone: 513-823-4146
  • Fax: 513-743-7570
Mailing address:
  • Phone: 513-823-4146
  • Fax: 513-743-7570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NYLA B SMITH
Title or Position: TREASURER
Credential: CNP
Phone: 513-212-9965