Provider Demographics
NPI:1093213043
Name:WELLNESS HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:WELLNESS HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:HUBBARD-POURIER
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, MPH
Authorized Official - Phone:505-895-4068
Mailing Address - Street 1:4300 CARLISLE BLVD NE STE 4
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4827
Mailing Address - Country:US
Mailing Address - Phone:505-895-4068
Mailing Address - Fax:505-883-9691
Practice Address - Street 1:4300 CARLISLE BLVD NE STE 4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4827
Practice Address - Country:US
Practice Address - Phone:505-373-2636
Practice Address - Fax:505-373-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty