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General NPI Number Information
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NPI Number | 1124252341
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Entity Type | Organization
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Legal Business Name | LONGVIEW WELLNESS CENTER, INC
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Dates
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Enumeration Date | 05/04/2009
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 1107 E MARSHALL AVE
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City | LONGVIEW
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State | TX
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Zip | 75601-5602
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Country | US
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Telephone | 903-758-2610
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Fax | 903-758-7081
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Provider Business Mailing Address
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Address Line | 1107 E MARSHALL AVE
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City | LONGVIEW
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State | TX
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Zip | 75601-5602
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Country | US
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Telephone | 903-758-2610
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Fax | 903-758-7081
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Authorized Official
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Title or Position | CEO
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Name | TIMOTHY CHAD JONES
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Credential |
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Telephone | 903-758-2610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 35168
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License Number State | TX
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