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General NPI Number Information
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NPI Number | 1245011006
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Entity Type | Organization
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Legal Business Name | MADE WHOLE MEDICAL CENTER LLC
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Dates
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Enumeration Date | 10/09/2023
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Last Update Date | 10/21/2023
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Provider Practice Location Address
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Address Line | 13048 W RANCHO SANTA FE BLVD
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City | AVONDALE
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State | AZ
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Zip | 85392-1705
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Country | US
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Telephone | 623-300-6457
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Fax | 855-300-5330
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Provider Business Mailing Address
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Address Line | 13048 W RANCHO SANTA FE BLVD
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City | AVONDALE
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State | AZ
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Zip | 85392-1705
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Country | US
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Telephone | 623-300-6457
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Fax | 855-300-5330
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Authorized Official
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Title or Position | OWNER
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Name | CAREMLA J BANKS
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Credential |
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Telephone | 623-300-6457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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