Provider Demographics
NPI:1073198073
Name:ZENLIGHTENMENT WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ZENLIGHTENMENT WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANCER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:989-285-1818
Mailing Address - Street 1:945 IOWA ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1467
Mailing Address - Country:US
Mailing Address - Phone:989-388-1880
Mailing Address - Fax:
Practice Address - Street 1:110 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1817
Practice Address - Country:US
Practice Address - Phone:989-285-1818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty