Provider Demographics
NPI:1063861557
Name:BE WELL THERAPEUTIC INNOVATIONS, LLC
Entity Type:Organization
Organization Name:BE WELL THERAPEUTIC INNOVATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LABRIE
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, OTR/L
Authorized Official - Phone:816-582-4181
Mailing Address - Street 1:6320 BROOKSIDE PLZ
Mailing Address - Street 2:UNIT 148
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-1709
Mailing Address - Country:US
Mailing Address - Phone:901-907-9491
Mailing Address - Fax:
Practice Address - Street 1:6320 BROOKSIDE PLZ
Practice Address - Street 2:UNIT 148
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-1709
Practice Address - Country:US
Practice Address - Phone:901-907-9491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011000123251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health