Provider Demographics
NPI:1609628619
Name:CASCADE WELLNESS CENTERS LLC
Entity Type:Organization
Organization Name:CASCADE WELLNESS CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUIKSHANK
Authorized Official - Suffix:
Authorized Official - Credentials:LPCA
Authorized Official - Phone:203-701-9424
Mailing Address - Street 1:8 ROSE LN APT 24-11
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-6724
Mailing Address - Country:US
Mailing Address - Phone:914-860-6971
Mailing Address - Fax:
Practice Address - Street 1:8 ROSE LN APT 24-11
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-6724
Practice Address - Country:US
Practice Address - Phone:914-860-6971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health