Two Roads Wellness Clinic, LLC
Organization Active NPI Primary Care Clinic/Center · Covington, IN
NPI 1639927296 · NPPES record last updated Feb 4, 2025
Key facts
- NPI
- 1639927296
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- TWO ROADS WELLNESS CLINIC, LLC
- Practice address
- 318 4TH St
Covington, IN 47932-1274 - Phone
- (765) 231-4193
- NPI assigned
- May 8, 2024
- Organization subpart
- No
Authorized official
- Name
- Jessica Nemecz
- Title
- Owner
- Phone
- (217) 651-6801
Other NPIs with the same Medicare PAC ID 1
Subparts reporting this organization as parent 1
Corporate family (same tax ID) 1
Practitioners 14
-
Heather Woods, LMHC, RPT
-
Jessica Irene Nemecz, MA, LPC, QMHP
-
Chelsie Sue Acord, FNP
-
Laura Green, LCSW
-
Jeffrey A Schroder, PT, MPT
-
Michel Dean Tozer, MSED., LCPC
-
Emily Cadman, LCSW
-
Ashley Crain, LPC
-
James G Russell, LCPC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D2300651 | Two Roads Wellness Clinic | Certificate of waiver | Mar 13, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241029002565 | IN | Part B Supplier - Clinic/Group Practice | 9638536220 |
Receives reassigned benefits from 3 practitioners Practice locations: Covington, IN |
National Provider Directory
- Tax ID family
- Two Roads Wellness Clinic
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor |
101Y00000X | |||
| Primary Care Clinic/Center | 261QP2300X | Yes | ||
| Rural Health Clinic/Center | 261QR1300X |
Addresses
Primary practice location
318 4TH St
Covington, IN 47932-1274
Mailing address
3545 N Vermilion St
Danville, IL 61832-1100
Phone (217) 651-6801
Other providers in Covington, IN
All providers in Covington, IN · Primary Care Clinic/Center in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 4, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.