Provider Demographics
NPI:1508801119
Name:PREVENTIVE HEALTH & WELLNESS GROUP, INC.
Entity Type:Organization
Organization Name:PREVENTIVE HEALTH & WELLNESS GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEVITA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-444-5151
Mailing Address - Street 1:14219 BRENTSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-1441
Mailing Address - Country:US
Mailing Address - Phone:800-742-2368
Mailing Address - Fax:937-291-2962
Practice Address - Street 1:14219 BRENTSHIRE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-1441
Practice Address - Country:US
Practice Address - Phone:832-249-6200
Practice Address - Fax:832-249-9205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTB009Medicare ID - Type Unspecified