Provider Demographics
NPI:1821539677
Name:MONARCH WELLNESS GROUP
Entity Type:Organization
Organization Name:MONARCH WELLNESS GROUP
Other - Org Name:MONARCH WELLNESS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIEDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:424-610-6814
Mailing Address - Street 1:11870 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 106570
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2276
Mailing Address - Country:US
Mailing Address - Phone:424-610-6814
Mailing Address - Fax:
Practice Address - Street 1:3122 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2533
Practice Address - Country:US
Practice Address - Phone:424-610-6814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty