Provider Demographics
NPI:1205668787
Name:GENERATIONAL WELLNESS
Entity type:Organization
Organization Name:GENERATIONAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-208-7584
Mailing Address - Street 1:25791 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6903
Mailing Address - Country:US
Mailing Address - Phone:951-259-3345
Mailing Address - Fax:
Practice Address - Street 1:25791 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-6903
Practice Address - Country:US
Practice Address - Phone:951-259-3345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)