MEDICARE: ULTIMATE WELLNESS PROVIDERS CO

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	174200000X	Meals Provider
2	177F00000X	Lodging Provider
3	251B00000X	Case Management Agency
4	251C00000X	Developmentally Disabled Services Day Training Agency
5	251E00000X	Home Health Agency
6	251F00000X	Home Infusion Agency
7	251J00000X	Nursing Care Agency
8	251V00000X	Voluntary or Charitable Agency
9	252Y00000X	Early Intervention Provider Agency
10	253Z00000X	In Home Supportive Care Agency
11	261Q00000X	Clinic/Center
12	261QA0600X	Adult Day Care Clinic/Center
13	261QC1800X	Corporate Health Clinic/Center
14	261QH0100X	Health Service Clinic/Center
15	261QH0100X	Health Service Clinic/Center	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1366970394	OTHER	TX	HOME HEALTH CARE SERVICES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1366970394	OTHER	LA	HOME HEALTH CARE SERVICES

General Provider Information

NPI Number	:	1710408448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTIMATE WELLNESS PROVIDERS CO

Provider Business Mailing Address
First Line	:	1880 S DAIRY ASHFORD RD STE 207-439
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-4760
Country	:	US
Telephone Number	:	877-768-4897
Fax Number	:

Provider Business Practice Location Address
First Line	:	1880 S DAIRY ASHFORD RD STE 207-439
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-4760
Country	:	US
Telephone Number	:	877-768-4897
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	LASONJA MALONE
Credential	:	CCMA
Telephone Number	:	877-768-4897

Provider Enumeration Date	:	07/03/2017
Last Update Date	:	01/19/2025

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Practice Fax: 877-768-4897

Directions to “ULTIMATE WELLNESS PROVIDERS CO ” Practice Location

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