Provider Demographics
NPI:1134507890
Name:ENHANCED HEALING WELLNESS CENTER
Entity Type:Organization
Organization Name:ENHANCED HEALING WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-457-1996
Mailing Address - Street 1:875 NE 79TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-4740
Mailing Address - Country:US
Mailing Address - Phone:786-457-1996
Mailing Address - Fax:
Practice Address - Street 1:875 NE 79TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-4740
Practice Address - Country:US
Practice Address - Phone:786-457-1996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder