Provider Demographics
NPI:1710241989
Name:KEY 2 BALANCE LLC
Entity Type:Organization
Organization Name:KEY 2 BALANCE LLC
Other - Org Name:WELLMINDED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVIGNE
Authorized Official - Suffix:
Authorized Official - Credentials:CADCII
Authorized Official - Phone:949-521-6890
Mailing Address - Street 1:16 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 173
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2355
Mailing Address - Country:US
Mailing Address - Phone:949-521-6890
Mailing Address - Fax:
Practice Address - Street 1:16 TECHNOLOGY
Practice Address - Street 2:SUITE 173
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2725
Practice Address - Country:US
Practice Address - Phone:949-521-6890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0405X
CAA7131111320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities