Provider Demographics
NPI:1497525679
Name:MAYSAH EHEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:MAYSAH EHEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUTENGWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASAPU-MWABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-559-5065
Mailing Address - Street 1:1147 BROOK FOREST AVE # 312
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-8845
Mailing Address - Country:US
Mailing Address - Phone:508-590-9085
Mailing Address - Fax:
Practice Address - Street 1:21349 WESTMINSTER LANE
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404
Practice Address - Country:US
Practice Address - Phone:815-714-9933
Practice Address - Fax:949-695-3321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty