NPIMap

Organization Active NPI

Prowellness Academy

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Westlake Village, CA
National Provider Identifier
1093348484
Registry record updated Feb 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
PROWELLNESS ACADEMY
Practice address
2945 Townsgate Rd Ste 200
Westlake Village, CA 91361-5866
Phone
(805) 342-0222
Fax
(805) 480-4965
NPI assigned
Feb 13, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cynthia McGruder-Kiefer
Title
Director/Owner
Phone
(805) 342-0222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

2945 Townsgate Rd Ste 200
Westlake Village, CA 91361-5866

Mailing address

2945 Townsgate Rd Ste 200
Westlake Village, CA 91361-5866
Phone (310) 739-8744

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200522002675 CA Part B Supplier - Clinic/Group Practice 4486075769 Receives reassigned benefits from 2 practitioners
Practice locations: Westlake Village, CA

National Provider Directory

National Provider Directory

Locations

300 E Esplanade Dr
Ste 903
Oxnard, CA 93036
Phone (805) 342-0222

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708041600000",
    "number": "1093348484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2945 TOWNSGATE RD STE 200",
            "city": "WESTLAKE VILLAGE",
            "state": "CA",
            "postal_code": "913615866",
            "telephone_number": "310-739-8744",
            "fax_number": "805-727-4499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2945 TOWNSGATE RD STE 200",
            "city": "WESTLAKE VILLAGE",
            "state": "CA",
            "postal_code": "913615866",
            "telephone_number": "805-342-0222",
            "fax_number": "805-480-4965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROWELLNESS ACADEMY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-13",
        "last_updated": "2024-02-16",
        "certification_date": "2024-01-18",
        "status": "A",
        "authorized_official_last_name": "MCGRUDER-KIEFER",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "805-342-0222"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westlake Village, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.