Provider Demographics
NPI:1689367799
Name:MAD HEALTH & WELLNESS
Entity Type:Organization
Organization Name:MAD HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NUTRITION SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:MADELEINE
Authorized Official - Middle Name:NAOMI
Authorized Official - Last Name:WEITZNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MA, RD
Authorized Official - Phone:303-720-4789
Mailing Address - Street 1:300 ROLLING OAKS DR APT 306
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1254
Mailing Address - Country:US
Mailing Address - Phone:303-720-4789
Mailing Address - Fax:
Practice Address - Street 1:300 ROLLING OAKS DR APT 306
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1254
Practice Address - Country:US
Practice Address - Phone:303-720-4789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1215646328Medicaid