Provider Demographics
NPI:1821702002
Name:PURSUITWELL, LLC
Entity Type:Organization
Organization Name:PURSUITWELL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RDN
Authorized Official - Prefix:
Authorized Official - First Name:KATALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:734-968-3599
Mailing Address - Street 1:14997 ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-4051
Mailing Address - Country:US
Mailing Address - Phone:734-968-3599
Mailing Address - Fax:
Practice Address - Street 1:14997 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-4051
Practice Address - Country:US
Practice Address - Phone:734-968-3599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
1518335306OtherINDIVIDUAL NPE