Provider Demographics
NPI:1003479643
Name:LIVING HOPE WELLNESS GROUP, INC
Entity Type:Organization
Organization Name:LIVING HOPE WELLNESS GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP, PMHNP-BC
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRYSTANYA
Authorized Official - Middle Name:ASHLE
Authorized Official - Last Name:ADENIJI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:916-844-4214
Mailing Address - Street 1:514 N CALIFORNIA AVE STE 18
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2120
Mailing Address - Country:US
Mailing Address - Phone:909-219-4142
Mailing Address - Fax:
Practice Address - Street 1:514 N CALIFORNIA AVE STE 18
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-2120
Practice Address - Country:US
Practice Address - Phone:909-219-4142
Practice Address - Fax:909-222-6918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty