Provider Demographics
NPI:1750814489
Name:FIRST LADIES WELLNESS ENTERPRISE
Entity Type:Organization
Organization Name:FIRST LADIES WELLNESS ENTERPRISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED DRUG COUNS
Authorized Official - Phone:310-351-5839
Mailing Address - Street 1:8204 AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-3125
Mailing Address - Country:US
Mailing Address - Phone:310-351-5839
Mailing Address - Fax:
Practice Address - Street 1:2207 BEECHWOOD ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-1782
Practice Address - Country:US
Practice Address - Phone:310-351-5839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health