Provider Demographics
NPI:1942513213
Name:HEALTH 1 WELLNESS CENTER
Entity Type:Organization
Organization Name:HEALTH 1 WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GOULET
Authorized Official - Suffix:
Authorized Official - Credentials:BUSINESS OWNER
Authorized Official - Phone:305-690-9784
Mailing Address - Street 1:700 IVES DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179
Mailing Address - Country:US
Mailing Address - Phone:305-690-9784
Mailing Address - Fax:305-690-9788
Practice Address - Street 1:700 IVES DAIRY RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-2425
Practice Address - Country:US
Practice Address - Phone:305-690-9784
Practice Address - Fax:305-690-9788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 9465208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty