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General NPI Number Information
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NPI Number | 1619600285
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Entity Type | Organization
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Legal Business Name | 444 WELLNESS LLC
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Dates
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Enumeration Date | 07/01/2022
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 60 NORTH SECOND ST
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City | GRANBY
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State | CO
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Zip | 80446
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Country | US
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Telephone | 970-557-4040
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 634
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City | GRANBY
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State | CO
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Zip | 80446-0634
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Country | US
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Telephone | 309-202-1693
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN HORNBAKER
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Credential | CRNA
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Telephone | 970-794-6444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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