MEDICARE: 2 LUV 1 ANOTHER WELLNESS & CARE CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	171400000X	Health & Wellness Coach
3	172A00000X	Driver
4	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
5	101YA0400X	Addiction (Substance Use Disorder) Counselor
6	171M00000X	Case Manager/Care Coordinator
7	101YM0800X	Mental Health Counselor
8	106S00000X	Behavior Technician
9	261QP2300X	Primary Care Clinic/Center
10	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1619767944	OTHER	AZ	MEDICAL DIRECTOR BERI NGWANG PMHNP
2	1649415126	OTHER	AZ	CLINICAL DIRECTOR JEFFREY GISHKIN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376272534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2 LUV 1 ANOTHER WELLNESS & CARE CENTER LLC

Provider Business Mailing Address
First Line	:	9322 W BONITOS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-6300
Country	:	US
Telephone Number	:	562-726-0415
Fax Number	:	602-609-3484

Provider Business Practice Location Address
First Line	:	2222 N 24TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-2716
Country	:	US
Telephone Number	:	602-975-6859
Fax Number	:	602-906-3484

Authorized Official
Title or Position	:	CHIEF EXECUTIVE DIRECTOR
Name	:	MS. SONYA JENNINGS
Credential	:	BA
Telephone Number	:	562-726-0415

Provider Enumeration Date	:	06/05/2022
Last Update Date	:	06/11/2026

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