Provider Demographics
NPI:1295386571
Name:UBUNTU INTEGRATIVE HEALTH LLC
Entity Type:Organization
Organization Name:UBUNTU INTEGRATIVE HEALTH LLC
Other - Org Name:SHANNON M MITCHELL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:561-789-7771
Mailing Address - Street 1:125 S STATE ROAD 7 STE 104-342
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4385
Mailing Address - Country:US
Mailing Address - Phone:561-289-4642
Mailing Address - Fax:561-257-1154
Practice Address - Street 1:125 S STATE ROAD 7 STE 104-342
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4385
Practice Address - Country:US
Practice Address - Phone:561-289-4642
Practice Address - Fax:561-257-1154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103700600Medicaid