Provider Demographics
NPI:1881204741
Name:PACIFIC WELLNESS LLC
Entity Type:Organization
Organization Name:PACIFIC WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAPPENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-261-2028
Mailing Address - Street 1:13403 N GOVERNMENT WAY UNIT 314
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8903
Mailing Address - Country:US
Mailing Address - Phone:208-261-2028
Mailing Address - Fax:
Practice Address - Street 1:13403 N GOVERNMENT WAY UNIT 314
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8903
Practice Address - Country:US
Practice Address - Phone:208-261-2028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty