Provider Demographics
NPI:1639656036
Name:HEIGHTS WELLNESS, INC
Entity Type:Organization
Organization Name:HEIGHTS WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-228-6152
Mailing Address - Street 1:440 REDONDO AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-5144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:440 REDONDO AVE STE 104
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-5144
Practice Address - Country:US
Practice Address - Phone:310-800-1442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty