Provider Demographics
NPI:1013410596
Name:OUR WELLNESS HUB
Entity Type:Organization
Organization Name:OUR WELLNESS HUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LATRESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-288-4772
Mailing Address - Street 1:17401 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1256
Mailing Address - Country:US
Mailing Address - Phone:866-336-9355
Mailing Address - Fax:
Practice Address - Street 1:17401 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1256
Practice Address - Country:US
Practice Address - Phone:866-336-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health