MEDICARE: CHARIS WELLNESS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1588510085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARIS WELLNESS, LLC

Provider Business Mailing Address
First Line	:	1105 S SUNSET DR
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85286-1872
Country	:	US
Telephone Number	:	480-531-4348
Fax Number	:	480-531-4348

Provider Business Practice Location Address
First Line	:	2909 S DOBSON RD STE 14
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-7900
Country	:	US
Telephone Number	:	480-531-4348
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AYOOLA OGEDENGBE
Credential	:	NP
Telephone Number	:	480-531-4348

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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