West Side Wellness
LBN: 360 Wellness Clinic Llc
West Side Wellness is an health care organization with primary practice located at 620 W South St Ste A , Benton AR 72015-4235. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Clinic/Center, Ambulatory Health Care Facilities / Rural Health. Ambulatory Health Care Facilities / Clinic/Center is the primary health care specialty.
360 Wellness Clinic Llc can be contacted via phone (501) 794-6123, or through Torres, Blake via phone (501) 778-3151.
Contact Information
Primary practice address
620 W South St Ste A
Benton AR 72015-4235
Phone: (501) 794-6123
Fax: (501) 794-6148
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Clinic/Center | 261Q00000X | ||
| Ambulatory Health Care Facilities / Rural Health | 261QR1300X |
Profile Details
| NPI number | 1366048803 |
|---|---|
| LBN Legal business name | 360 Wellness Clinic Llc |
| DBA Doing business as | West Side Wellness |
| Authorized official | Torres, Blake |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Dec 9th, 2020 |
| Last updated | May 9th, 2022 - about 2 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1366048803 | NPPES |
| Arkansas | MEDICAID | 119185001 | |
| Arkansas | Other | 1205911849 |
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