Provider Demographics
NPI:1477215069
Name:ULTIMATE WELLNESS PROVIDERS CO
Entity Type:Organization
Organization Name:ULTIMATE WELLNESS PROVIDERS CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:LASONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:CCMA
Authorized Official - Phone:877-768-4897
Mailing Address - Street 1:4914 BISSONNET ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4047
Mailing Address - Country:US
Mailing Address - Phone:877-768-4897
Mailing Address - Fax:832-213-3075
Practice Address - Street 1:4914 BISSONNET ST STE 101
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4047
Practice Address - Country:US
Practice Address - Phone:877-768-4897
Practice Address - Fax:832-213-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Multi-Specialty
No251F00000XAgenciesHome Infusion
No253Z00000XAgenciesIn Home Supportive Care
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty