MEDICARE: THE FAMILY WELLNESS CENTER, INC

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
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1609141704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FAMILY WELLNESS CENTER, INC

Provider Business Mailing Address
First Line	:	2526 PENNSYLVANIA AVE SE
Second Line	:	SUITE C
City	:	WASHINGTON
State	:	DC
Zip	:	20020-6719
Country	:	US
Telephone Number	:	202-525-1607
Fax Number	:	202-525-3894

Provider Business Practice Location Address
First Line	:	2526 PENNSYLVANIA AVE SE
Second Line	:	SUITE C
City	:	WASHINGTON
State	:	DC
Zip	:	20020-6719
Country	:	US
Telephone Number	:	202-525-1607
Fax Number	:	202-525-3894

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WENDELL BRIAN FALBY
Credential	:
Telephone Number	:	202-525-1607

Provider Enumeration Date	:	03/21/2012
Last Update Date	:	06/04/2014

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