Provider Demographics
NPI:1760084644
Name:BEYOND4WALLZ HEALTH AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:BEYOND4WALLZ HEALTH AND WELLNESS CENTER LLC
Other - Org Name:BEYOND4WALLZ HEALTH AND WELLNESS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARIELLE
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-935-2409
Mailing Address - Street 1:14231 N 7TH ST STE B7
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4362
Mailing Address - Country:US
Mailing Address - Phone:586-935-2409
Mailing Address - Fax:
Practice Address - Street 1:14231 N 7TH ST STE B7
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4362
Practice Address - Country:US
Practice Address - Phone:602-228-8818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-14
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health