Provider Demographics
NPI:1295582344
Name:AMICUS HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:AMICUS HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SALEH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHATI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, MPH, CPH
Authorized Official - Phone:480-809-1765
Mailing Address - Street 1:2111 E BASELINE RD STE C8
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1521
Mailing Address - Country:US
Mailing Address - Phone:480-809-1765
Mailing Address - Fax:949-703-7446
Practice Address - Street 1:2111 E BASELINE RD STE C8
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1521
Practice Address - Country:US
Practice Address - Phone:480-809-1765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty