Provider Demographics
NPI:1134662281
Name:THREE MOUNTAINS WELLNESS, LLC
Entity Type:Organization
Organization Name:THREE MOUNTAINS WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-763-1497
Mailing Address - Street 1:4088 BEEMAN RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48895-9349
Mailing Address - Country:US
Mailing Address - Phone:517-763-1497
Mailing Address - Fax:
Practice Address - Street 1:1780 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4998
Practice Address - Country:US
Practice Address - Phone:517-763-1497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000190261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty