Provider Demographics
NPI:1447417282
Name:WELLNESS TO GO LLC
Entity Type:Organization
Organization Name:WELLNESS TO GO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:602-841-4860
Mailing Address - Street 1:2200 W BETHANY HOME RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-1997
Mailing Address - Country:US
Mailing Address - Phone:602-841-4860
Mailing Address - Fax:602-841-4861
Practice Address - Street 1:2200 W BETHANY HOME RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1997
Practice Address - Country:US
Practice Address - Phone:602-841-4860
Practice Address - Fax:602-841-4861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty