Provider Demographics
NPI:1518633445
Name:DIVERSIFIED HEALTH & WELLNESS SOLUTIONS, LLC
Entity Type:Organization
Organization Name:DIVERSIFIED HEALTH & WELLNESS SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANEDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:281-393-7249
Mailing Address - Street 1:2923 ASHLYN ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-2152
Mailing Address - Country:US
Mailing Address - Phone:281-793-0437
Mailing Address - Fax:
Practice Address - Street 1:2923 ASHLYN ARBOR DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-2152
Practice Address - Country:US
Practice Address - Phone:281-793-0437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service