Provider Demographics
NPI:1619600285
Name:444 WELLNESS LLC
Entity Type:Organization
Organization Name:444 WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:970-794-6444
Mailing Address - Street 1:PO BOX 634
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CO
Mailing Address - Zip Code:80446-0634
Mailing Address - Country:US
Mailing Address - Phone:309-202-1693
Mailing Address - Fax:
Practice Address - Street 1:60 NORTH SECOND ST
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CO
Practice Address - Zip Code:80446
Practice Address - Country:US
Practice Address - Phone:970-557-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-01
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty