Provider Demographics
NPI:1144583592
Name:CONTINUUM WELLNESS CLINIC, LLC
Entity Type:Organization
Organization Name:CONTINUUM WELLNESS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:616-356-5000
Mailing Address - Street 1:3941 E BASELINE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2750
Mailing Address - Country:US
Mailing Address - Phone:480-503-2010
Mailing Address - Fax:480-503-2300
Practice Address - Street 1:1075 S IDAHO RD
Practice Address - Street 2:SUITE 210
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85119-6496
Practice Address - Country:US
Practice Address - Phone:480-983-0877
Practice Address - Fax:480-983-3172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8062332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies