Healthcare Provider Details

I. General information

NPI: 1568471779
Provider Name (Legal Business Name): MARANATHA WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E BARNARD STREET
BLYTHE CA
92225
US

IV. Provider business mailing address

PO BOX 1551
BLYTHE CA
92226
US

V. Phone/Fax

Practice location:
  • Phone: 760-922-7790
  • Fax: 760-922-2259
Mailing address:
  • Phone: 760-922-7790
  • Fax: 760-922-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateCA

VIII. Authorized Official

Name: NICKOLAS LLOYD LIND
Title or Position: PRESIDENT
Credential:
Phone: 760-922-0002