Organization
360 WELLNESS CLINIC LLC
Active
Organization
360 WELLNESS CLINIC LLC
Active
Other names
West Side Wellness, The Shot Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
BLAKE TORRES (OWNER)
(501) 778-3151
Entity
Organization
Contact information
Practice address
620 W SOUTH ST STE A, BENTON, AR 72015-4235
(501) 794-6123
(501) 794-6148
Mailing address
620 W SOUTH ST STE A, BENTON, AR 72015-4235
(501) 794-6123
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119185001
—
AR
01
—
1205911849
NPI
AR
Enumeration date
12/09/2020
Last updated
05/09/2022
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