Provider Demographics
NPI:1821349895
Name:LIFE HEALTH AND WELLNESS HEALTH CARE
Entity Type:Organization
Organization Name:LIFE HEALTH AND WELLNESS HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS-CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,FNP-BC
Authorized Official - Phone:888-958-5736
Mailing Address - Street 1:PO BOX 974
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85311-0974
Mailing Address - Country:US
Mailing Address - Phone:888-958-5736
Mailing Address - Fax:888-958-5737
Practice Address - Street 1:5040 N 15TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3329
Practice Address - Country:US
Practice Address - Phone:888-958-5736
Practice Address - Fax:888-958-5737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP 3114363LA2200X
AZAP1707363LF0000X
AZAP1705363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty