MEDICARE: WARR ON WELLNESS, 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
1	251S00000X	Community/Behavioral Health Agency	1407249782	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1740673847	OTHER	TX	ANGELA WARR
2	1407249782	OTHER	TX	DR. DARRELL C. HARTLEY

General Provider Information

NPI Number	:	1740674563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARR ON WELLNESS, LLC

Provider Business Mailing Address
First Line	:	4524 LEE ST
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75010-4157
Country	:	US
Telephone Number	:	972-741-3760
Fax Number	:

Provider Business Practice Location Address
First Line	:	4524 LEE ST
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75010-4157
Country	:	US
Telephone Number	:	972-741-3760
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANGELA FAYE WARR
Credential	:	MA, MS, CAMS-S, PWC
Telephone Number	:	972-741-3760

Provider Enumeration Date	:	03/19/2015
Last Update Date	:	03/19/2015

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