Provider Demographics
NPI:1326654393
Name:PEACE HEALTH AND WELLNESS CLINIC
Entity Type:Organization
Organization Name:PEACE HEALTH AND WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUBUNMI
Authorized Official - Middle Name:ROSELINE
Authorized Official - Last Name:AWE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:214-400-2000
Mailing Address - Street 1:830 MAYFIELD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3728
Mailing Address - Country:US
Mailing Address - Phone:469-999-0009
Mailing Address - Fax:469-242-9693
Practice Address - Street 1:830 MAYFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3728
Practice Address - Country:US
Practice Address - Phone:469-999-0009
Practice Address - Fax:469-242-9693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care