MEDICARE: BRAVE HEARTS WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1326931791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAVE HEARTS WELLNESS, LLC

Provider Business Mailing Address
First Line	:	608 W MISSION LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-3541
Country	:	US
Telephone Number	:	818-732-7338
Fax Number	:

Provider Business Practice Location Address
First Line	:	9100 N CENTRAL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2430
Country	:	US
Telephone Number	:	480-664-4641
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ELSIE KALULE
Credential	:
Telephone Number	:	818-732-7338

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	06/04/2025

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