NPIMap

Organization Active NPI

Wellness Card LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dayton, OH
National Provider Identifier
1558678151
Registry record updated Sep 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
WELLNESS CARD LLC
Practice address
1320 Woodman Dr
Dayton, OH 45432-3497
Phone
(937) 223-1781
Fax
(937) 424-8656
NPI assigned
Sep 3, 2010
Last updated
Sep 3, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2010

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

Authorized official

Name
Mr. Jeffrey Frank Kolaczkowski, MSW, LISW, LCSWNPI 1821070137
Title
Owner/Director
Phone
(937) 223-1781

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

1320 Woodman Dr
Dayton, OH 45432-3497

Mailing address

1320 Woodman Dr
Dayton, OH 45432-3497
Phone (937) 223-1781

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110314001091 OH Part B Supplier - Clinic/Group Practice 6800078791 Receives reassigned benefits from 17 practitioners
Practice locations: Dayton, OH

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1283472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283472000000",
    "number": "1558678151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 WOODMAN DR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454323497",
            "telephone_number": "937-223-1781",
            "fax_number": "937-424-8656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 WOODMAN DR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454323497",
            "telephone_number": "937-223-1781",
            "fax_number": "937-424-8656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS CARD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-03",
        "last_updated": "2010-09-03",
        "status": "A",
        "authorized_official_last_name": "KOLACZKOWSKI",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "FRANK",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "937-223-1781",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW, LISW, LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2010; 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.