Healthcare Provider Details

I. General information

NPI: 1700790599
Provider Name (Legal Business Name): WELLNESS HOUSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 E 54TH ST
LOS ANGELES CA
90011-4919
US

IV. Provider business mailing address

17215 STUDEBAKER RD STE 110
CERRITOS CA
90703-2521
US

V. Phone/Fax

Practice location:
  • Phone: 562-716-4568
  • 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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAQIB IQBAL
Title or Position: PRESIDENT & CEO
Credential:
Phone: 562-716-6726