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General NPI Number Information
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NPI Number | 1629654140
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Entity Type | Organization
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Legal Business Name | 360-WELLNESS CENTER
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 3008 SUDBURY DR
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City | KETTERING
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State | OH
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Zip | 45420-1129
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Country | US
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Telephone | 937-310-1269
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Fax | 937-310-1199
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Provider Business Mailing Address
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Address Line | 2413 BARNETT DR
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City | BELLBROOK
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State | OH
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Zip | 45305-1705
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Country | US
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Telephone | 937-668-6633
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANTHONY A BROWN JR.
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Credential | LICDC
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Telephone | 937-668-6633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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