Provider Demographics
NPI:1447773825
Name:360 WELLNESS SOLUTIONS, LLC
Entity Type:Organization
Organization Name:360 WELLNESS SOLUTIONS, LLC
Other - Org Name:360 WELLNESS SOLUTIONS MOBILE AND TELEHEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:JOSEPHINE
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PT
Authorized Official - Phone:760-832-8025
Mailing Address - Street 1:194 LOCH LOMOND RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-5600
Mailing Address - Country:US
Mailing Address - Phone:760-832-8025
Mailing Address - Fax:760-764-4010
Practice Address - Street 1:194 LOCH LOMOND RD
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-5600
Practice Address - Country:US
Practice Address - Phone:760-832-8025
Practice Address - Fax:760-764-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1447773825OtherANTHEM
CA1285033878OtherCASH