Provider Demographics
NPI:1154678670
Name:HEART OF WELLNESS INC
Entity Type:Organization
Organization Name:HEART OF WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-570-0401
Mailing Address - Street 1:205 CLARK PL SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4062
Mailing Address - Country:US
Mailing Address - Phone:360-570-0401
Mailing Address - Fax:360-570-2060
Practice Address - Street 1:205 CLARK PL SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4062
Practice Address - Country:US
Practice Address - Phone:360-570-0401
Practice Address - Fax:360-570-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center