| Details | Last Recertification Date | Update | Recertification | 1/29/2024 11:28:45 AM | 3/4/2025 3:35:40 PM | 3/4/2025 3:35 PM |
| Contacts | Primary Contact | Update | PC Change Request | Richardson, Tamiko
Corporate Compliance Officer
Wellness Pointe
9032124771 | Womack, Drew
Chief Operations and Compliance Officer
Wellness Pointe
9032124752 | 2/24/2025 11:25 AM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2023 11:31:35 AM | 1/29/2024 11:28:45 AM | 1/29/2024 11:28 AM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2022 3:02:34 PM | 2/1/2023 11:31:35 AM | 2/1/2023 11:31 AM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2021 12:08:30 PM | 1/31/2022 3:02:34 PM | 1/31/2022 3:02 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 2/3/2021 12:08 PM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 286082701 | 2/3/2021 12:08 PM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | TX | 2/3/2021 12:08 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 2/3/2021 12:08 PM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 183824501 | 2/3/2021 12:08 PM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | TX | 2/3/2021 12:08 PM |
| Medicaid Billing | Medicaid: Number | Delete | Recertification | 1838245-01 (TX) | | 2/3/2021 12:08 PM |
| Medicaid Billing | Medicaid: Number | Delete | Recertification | 2860827-01 (TX) | | 2/3/2021 12:08 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1942269493 ( ) | | 2/3/2021 12:08 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1790955847 ( ) | | 2/3/2021 12:08 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1790955847 | 2/3/2021 12:08 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | TX | 2/3/2021 12:08 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1942269493 | 2/3/2021 12:08 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | TX | 2/3/2021 12:08 PM |
| Details | Last Recertification Date | Update | Recertification | 1/28/2020 10:50:43 AM | 2/3/2021 12:08:30 PM | 2/3/2021 12:08 PM |
| Details | Last Recertification Date | Update | Recertification | 2/2/2019 8:56:05 AM | 1/28/2020 10:50:43 AM | 1/28/2020 10:50 AM |
| Details | Last Recertification Date | Update | Recertification | 2/13/2018 2:25:31 PM | 2/2/2019 8:56:05 AM | 2/2/2019 8:56 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Richardson, Tamiko
Quality and Compliance Director
Wellness Pointe
9032124771 | Richardson, Tamiko
Corporate Compliance Officer
Wellness Pointe
9032124771 | 1/25/2019 1:26 PM |
| Contacts | Primary Contact | Update | Recertification | Jones, Chad
Chief Executive Officer
Wellness Pointe
9032124777 | Richardson, Tamiko
Quality and Compliance Director
Wellness Pointe
9032124771 | 2/13/2018 2:25 PM |
| Details | Last Recertification Date | Update | Recertification | 1/27/2017 12:00:00 AM | 2/13/2018 2:25:31 PM | 2/13/2018 2:25 PM |
| Contacts | Authorizing Official | Update | | Jones, Chad
Chief Executive Officer
9032124777 | Jones, Chad
Chief Executive Officer
Wellness Pointe
9032124777 | 1/8/2018 3:52 PM |
| Contacts | Primary Contact | Update | | Jones, Chad
Chief Executive Officer
9032124777 | Jones, Chad
Chief Executive Officer
Wellness Pointe
9032124777 | 1/8/2018 3:52 PM |
| Contacts | Authorizing Official | Update | | Kendrick, Jim
Interim CEO
9032124777 | Jones, Chad
Chief Executive Officer
9032124777 | 5/1/2017 3:12 PM |
| Contacts | Primary Contact | Update | | Sharp, Zack
Corporate Compliance Officer
9032124771-209 | Jones, Chad
Chief Executive Officer
9032124777 | 5/1/2017 3:12 PM |
| Addresses | Main Address | Insert | | |
602 Titus St STE 130
Gilmer, TX 75644-1780 | 1/27/2017 3:14 PM |
| Details | Last Recertification Date | Update | | 2/26/2016 12:00:00 AM | 1/27/2017 12:00:00 AM | 1/27/2017 3:14 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 2/26/2016 12:03 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 1838245-01 | 2/26/2016 12:03 PM |
| Medicaid Billing | Medicaid: State | Insert | | | TX | 2/26/2016 12:03 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 2/26/2016 12:03 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 2860827-01 | 2/26/2016 12:03 PM |
| Medicaid Billing | Medicaid: State | Insert | | | TX | 2/26/2016 12:03 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1942269493 | 2/26/2016 12:03 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1790955847 | 2/26/2016 12:03 PM |
| Details | Last Recertification Date | Update | | 1/28/2015 12:00:00 AM | 2/26/2016 12:00:00 AM | 2/26/2016 12:03 PM |
| Details | Last Recertification Date | Update | | 3/23/2014 12:00:00 AM | 1/28/2015 12:00:00 AM | 1/28/2015 3:33 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/23/2014 12:00:00 AM | 3/23/2014 2:43 PM |
| Details | Entity Subname | Update | | Wellness Pointe Gilmer | Longview Wellness Center - Gilmer | 3/23/2014 2:43 PM |
| Contacts | Primary Contact | Insert | | | Sharp, Zack
Corporate Compliance Officer
9032124771-209 | 11/20/2013 8:56 PM |
| Addresses | Billing Address | Insert | | | LONGVIEW WELLNESS CENTER
1107 E. MARSHALL AVENUE
LONGVIEW, TX 75601 | 9/27/2013 1:13 PM |
| Contacts | Authorizing Official | Update | | SWANK, DIANNE
CEO/EXECUTIVE DIRECTOR
9037582610 | Kendrick, Jim
Interim CEO
9032124777 | 9/13/2013 3:45 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/1/2013 12:03 PM |
| Details | Entity Name | Update | | LONGVIEW WELLNESS CENTER | LONGVIEW WELLNESS CENTER, INC. | 3/29/2012 10:51 AM |
| Details | Entity Subname | Update | | GILMER | Wellness Pointe Gilmer | 3/29/2012 10:51 AM |
| Details | Comments Public | Insert | | | 3/29/12 - Added Inc. to name and added sub name,added suite to main address, changed AO from DIANNE SWANK. | 3/29/2012 10:51 AM |
| Contacts | Authorizing Official | Insert | | | SWANK, DIANNE
CEO/EXECUTIVE DIRECTOR
9037582610 | 5/19/2011 9:22 AM |
| Details | Last Recertification Date | Insert | | | | 5/19/2011 9:19 AM |
| Details | Grant Number | Insert | | | H80CS08217 | 5/19/2011 9:19 AM |
| Details | 340B ID | Insert | | | CHC08217-02 | 5/19/2011 9:19 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 5/19/2011 9:19 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 5/19/2011 9:19 AM |
| Details | Medicare Provider Number | Insert | | | | 5/19/2011 9:19 AM |
| Details | Entity Name | Insert | | | LONGVIEW WELLNESS CENTER | 5/19/2011 9:19 AM |
| Details | Program Code | Insert | | | CH | 5/19/2011 9:19 AM |
| Details | Entity Subname | Insert | | | GILMER | 5/19/2011 9:19 AM |
| Dates | Participating Approval Date | Insert | | | 9/17/2009 12:00:00 AM | 5/19/2011 9:19 AM |
| Details | State | Insert | | | Active | 5/19/2011 9:19 AM |
| Dates | Registration Date | Insert | | | 8/31/2009 12:00:00 AM | 5/19/2011 9:19 AM |
| Dates | Signed By Date | Insert | | | 6/16/2009 12:00:00 AM | 5/19/2011 9:19 AM |
| Dates | Start Date | Insert | | | 10/1/2009 12:00:00 AM | 5/19/2011 9:19 AM |
| Terminations | Termination Comments | Insert | | | | 5/19/2011 9:19 AM |
| Terminations | Termination Date | Insert | | | | 5/19/2011 9:19 AM |
| Terminations | Termination Effective Date | Insert | | | | 5/19/2011 9:19 AM |
| Terminations | Termination Reason | Insert | | | | 5/19/2011 9:19 AM |