Provider Demographics
NPI:1346856341
Name:WHITE HORSE HEALTH AND WELLNESS CENTERS, LLC.
Entity Type:Organization
Organization Name:WHITE HORSE HEALTH AND WELLNESS CENTERS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-717-4951
Mailing Address - Street 1:4125 PORTOFINO DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-4172
Mailing Address - Country:US
Mailing Address - Phone:303-717-4951
Mailing Address - Fax:
Practice Address - Street 1:825 DELAWARE AVE STE 303C
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6169
Practice Address - Country:US
Practice Address - Phone:303-776-0995
Practice Address - Fax:
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
Yes251E00000XAgenciesHome Health