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NPI Code Detail

MEDICARE: WELLMORE CENTRE LLC

MEDICARE: WELLMORE CENTRE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1487150470
Entity Type Code : Organization
Provider Name (Legal Business Name) : WELLMORE CENTRE LLC
Provider Business Mailing Address
First Line : 204 2ND ST NE
Second Line :
City : NEW PHILADELPHIA
State : OH
Zip : 44663-2808
Country : US
Telephone Number : 234-801-2469
Fax Number : 330-364-9212
Provider Business Practice Location Address
First Line : 204 2ND ST NE
Second Line :
City : NEW PHILADELPHIA
State : OH
Zip : 44663-2808
Country : US
Telephone Number : 234-801-2469
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MARK ANDREW WELTY
Credential :
Telephone Number : 330-704-6998
Provider Enumeration Date : 03/30/2018
Last Update Date : 03/28/2022

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Directions to “WELLMORE CENTRE LLC ” Practice Location

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