Provider Demographics
NPI:1437651122
Name:BEST WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:BEST WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:GISSELLE
Authorized Official - Last Name:BOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-395-8622
Mailing Address - Street 1:8181 NW 36TH ST STE 5C
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6628
Mailing Address - Country:US
Mailing Address - Phone:305-364-4949
Mailing Address - Fax:786-409-5388
Practice Address - Street 1:8181 NW 36TH ST STE 5C
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6628
Practice Address - Country:US
Practice Address - Phone:305-364-4949
Practice Address - Fax:786-409-5388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid