Provider Demographics
NPI:1568471779
Name:MARANATHA WELLNESS CENTER
Entity Type:Organization
Organization Name:MARANATHA WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICKOLAS
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:LIND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-922-0002
Mailing Address - Street 1:PO BOX 1551
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92226
Mailing Address - Country:US
Mailing Address - Phone:760-922-7790
Mailing Address - Fax:760-922-2259
Practice Address - Street 1:415 E BARNARD STREET
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225
Practice Address - Country:US
Practice Address - Phone:760-922-7790
Practice Address - Fax:760-922-2259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310400000X, 311Z00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Not Answered385H00000XRespite Care FacilityRespite Care