Healthcare Provider Details

I. General information

NPI: 1619600285
Provider Name (Legal Business Name): 444 WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 NORTH SECOND ST
GRANBY CO
80446
US

IV. Provider business mailing address

PO BOX 634
GRANBY CO
80446-0634
US

V. Phone/Fax

Practice location:
  • Phone: 970-557-4040
  • Fax:
Mailing address:
  • Phone: 309-202-1693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN HORNBAKER
Title or Position: OWNER
Credential: CRNA
Phone: 970-794-6444