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General NPI Number Information
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NPI Number | 1588366777
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Entity Type | Organization
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Legal Business Name | ESSENTIAL HEALTH AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 4515 S MCCLINTOCK DR STE 209
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City | TEMPE
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State | AZ
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Zip | 85282-7382
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Country | US
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Telephone | 480-831-3057
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Fax |
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Provider Business Mailing Address
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Address Line | 4515 S MCCLINTOCK DR STE 209
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City | TEMPE
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State | AZ
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Zip | 85282-7382
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Country | US
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Telephone | 480-831-3057
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ISRAEL CANNON
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Credential |
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Telephone | 480-831-3057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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