MEDICARE: COREBELLA HEALTH AND 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1992486955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COREBELLA HEALTH AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	4600 MONTGOMERY RD STE 400
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2600
Country	:	US
Telephone Number	:	833-510-4357
Fax Number	:

Provider Business Practice Location Address
First Line	:	4926 E MCDOWELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-4294
Country	:	US
Telephone Number	:	833-510-4357
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHAD SMITH
Credential	:
Telephone Number	:	833-510-4357

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	12/02/2024

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