Healthcare Provider Details

I. General information

NPI: 1114854874
Provider Name (Legal Business Name): SOLACE WELLNESS CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N 24TH ST STE D104
PHOENIX AZ
85016-7353
US

IV. Provider business mailing address

3150 N 24TH ST STE D104
PHOENIX AZ
85016-7353
US

V. Phone/Fax

Practice location:
  • Phone: 602-521-8159
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGE NGOGA
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 412-716-6267