Provider Demographics
NPI:1710245600
Name:SHEA WELLNESS GROUP LLC
Entity Type:Organization
Organization Name:SHEA WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:602-569-0223
Mailing Address - Street 1:10401 N 32ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3850
Mailing Address - Country:US
Mailing Address - Phone:602-569-0223
Mailing Address - Fax:602-334-1976
Practice Address - Street 1:10401 N 32ND ST STE A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3850
Practice Address - Country:US
Practice Address - Phone:602-569-0223
Practice Address - Fax:602-334-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty