Provider Demographics
NPI:1598371700
Name:MAJESTY WELLNESS & HOUSECALLS,LLC
Entity Type:Organization
Organization Name:MAJESTY WELLNESS & HOUSECALLS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:SHEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKS
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:954-867-8861
Mailing Address - Street 1:1202SW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068
Mailing Address - Country:US
Mailing Address - Phone:954-867-8861
Mailing Address - Fax:
Practice Address - Street 1:1202 SW 82ND AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068
Practice Address - Country:US
Practice Address - Phone:954-867-8861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251E00000XAgenciesHome Health