Provider Demographics
NPI:1437812807
Name:ANEW MIND BODY CONNECT LLC
Entity Type:Organization
Organization Name:ANEW MIND BODY CONNECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO-CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLENE
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-758-9357
Mailing Address - Street 1:1121 WANDERING WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-6132
Mailing Address - Country:US
Mailing Address - Phone:561-758-9357
Mailing Address - Fax:
Practice Address - Street 1:1121 WANDERING WILLOW WAY
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-6132
Practice Address - Country:US
Practice Address - Phone:866-738-0854
Practice Address - Fax:866-598-3579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health