Provider Demographics
NPI:1356609838
Name:HEALTHFLY SENIOR WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:HEALTHFLY SENIOR WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEONZA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:THYMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-972-2445
Mailing Address - Street 1:3858 W CARSON ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-6709
Mailing Address - Country:US
Mailing Address - Phone:480-718-5986
Mailing Address - Fax:480-664-6813
Practice Address - Street 1:3858 W CARSON ST
Practice Address - Street 2:SUITE 121
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6709
Practice Address - Country:US
Practice Address - Phone:480-718-5986
Practice Address - Fax:480-664-6813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy