MEDICARE: HEALING ANGEL WELLNESS CENTER, 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	:	1811602857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING ANGEL WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	4040 E MCDOWELL RD STE 320
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-4447
Country	:	US
Telephone Number	:	602-281-5504
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 E MCDOWELL RD STE 318320
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-4414
Country	:	US
Telephone Number	:	602-281-5504
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ABDIHAKIN ADEN
Credential	:
Telephone Number	:	602-281-5504

Provider Enumeration Date	:	01/13/2023
Last Update Date	:	09/30/2024

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