Healthcare Provider Details

I. General information

NPI: 1144583592
Provider Name (Legal Business Name): CONTINUUM WELLNESS CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 S IDAHO RD SUITE 210
APACHE JUNCTION AZ
85119-6496
US

IV. Provider business mailing address

3941 E BASELINE RD SUITE 101
GILBERT AZ
85234-2750
US

V. Phone/Fax

Practice location:
  • Phone: 480-983-0877
  • Fax: 480-983-3172
Mailing address:
  • Phone: 480-503-2010
  • Fax: 480-503-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number8062
License Number StateAZ

VIII. Authorized Official

Name: STEVE DAVIDSON
Title or Position: MANAGING MEMBER
Credential: P.T.
Phone: 616-356-5000