Provider Demographics
NPI:1659728459
Name:BAILEY HOUSE OF WELLNESS, LLC
Entity Type:Organization
Organization Name:BAILEY HOUSE OF WELLNESS, LLC
Other - Org Name:BHOW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:IESHAI
Authorized Official - Middle Name:T
Authorized Official - Last Name:BAILEY-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,LMHC,CST
Authorized Official - Phone:954-903-7611
Mailing Address - Street 1:1881 NE 26TH ST
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1416
Mailing Address - Country:US
Mailing Address - Phone:954-903-7611
Mailing Address - Fax:954-204-3291
Practice Address - Street 1:1881 NE 26TH ST
Practice Address - Street 2:SUITE 202A
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1416
Practice Address - Country:US
Practice Address - Phone:954-903-7611
Practice Address - Fax:954-204-3291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-21
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH12272251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health