Wellness Detox la LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

WELLNESS DETOX LA LLC

Practice address

631 E Phillips Blvd
Pomona, CA 91766-4569

Phone

(909) 589-6783

Fax

(949) 606-0488

NPI assigned

Feb 12, 2025

Organization subpart

No

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

Authorized official

Name

Mr. Nicholas Adam Petrillo

Title

Ceo

Phone

(978) 440-3200

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1739318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739318400000",
    "number": "1689489023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 NW 53RD ST STE 370",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334878241",
            "telephone_number": "978-440-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 E PHILLIPS BLVD",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917664569",
            "telephone_number": "909-589-6783",
            "fax_number": "949-606-0488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS DETOX LA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-12",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A",
        "authorized_official_last_name": "PETRILLO",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "ADAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "978-440-3200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Pomona, CA
• Providers in Pomona, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.