Provider Demographics
NPI:1619446440
Name:HEALTHY YOU LIFESTYLE CENTER
Entity Type:Organization
Organization Name:HEALTHY YOU LIFESTYLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMMAKANTI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-656-1029
Mailing Address - Street 1:13225 CARIS CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-3249
Mailing Address - Country:US
Mailing Address - Phone:919-656-1029
Mailing Address - Fax:
Practice Address - Street 1:13225 CARIS CT
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-3249
Practice Address - Country:US
Practice Address - Phone:919-656-1029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHY YOU LIFESTYLE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-22
Last Update Date:2018-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service