Healthcare Provider Details

I. General information

NPI: 1528715323
Provider Name (Legal Business Name): UNIVERSAL WELLNESS 360
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 W ORION ST STE C-5
TEMPE AZ
85283-5603
US

IV. Provider business mailing address

5411 BLUEGRASS DR
ATLANTA GA
30349-2959
US

V. Phone/Fax

Practice location:
  • Phone: 925-316-3558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ZARED LLOYD
Title or Position: OFFICER
Credential:
Phone: 925-316-3558