Provider Demographics
NPI:1467989996
Name:AUSTIN HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:AUSTIN HEALTH & WELLNESS LLC
Other - Org Name:STAR WELLNESS AUSTIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN EEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-571-6425
Mailing Address - Street 1:451 WESTPARK WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3703
Mailing Address - Country:US
Mailing Address - Phone:817-571-6425
Mailing Address - Fax:
Practice Address - Street 1:451 WESTPARK WAY STE 5
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3703
Practice Address - Country:US
Practice Address - Phone:817-571-6425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health