Provider Demographics
NPI:1093964546
Name:A WELL FOR HEALTH INC
Entity Type:Organization
Organization Name:A WELL FOR HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEILBRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-466-3954
Mailing Address - Street 1:1530 BISHOPS LODGE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-0005
Mailing Address - Country:US
Mailing Address - Phone:505-983-1293
Mailing Address - Fax:
Practice Address - Street 1:1530 BISHOPS LODGE RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-0005
Practice Address - Country:US
Practice Address - Phone:505-983-1293
Practice Address - Fax:505-467-8309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063434174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNMB2362Medicare PIN