Provider Demographics
NPI:1619591179
Name:BLACK WELLNESS & PROSPERITY CENTER
Entity Type:Organization
Organization Name:BLACK WELLNESS & PROSPERITY CENTER
Other - Org Name:BLACK WELLNESS & PROSPERITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANTAY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:DAVIES-BALCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-790-1905
Mailing Address - Street 1:2201 CALAVERAS ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2201 CALAVERAS ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1103
Practice Address - Country:US
Practice Address - Phone:559-478-5912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center