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General NPI Number Information
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NPI Number | 1891575890
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Entity Type | Organization
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Legal Business Name | TIME WELLNESS AR
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Dates
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Enumeration Date | 10/05/2023
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 4220 N CROSSOVER RD STE 102
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4593
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Country | US
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Telephone | 954-654-2350
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Fax |
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Provider Business Mailing Address
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Address Line | 4220 N CROSSOVER RD STE 102
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4593
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Country | US
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Telephone | 954-654-2350
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DANIEL E FESEFELDT III
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Credential |
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Telephone | 954-654-2350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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