Provider Demographics
NPI:1457040594
Name:PALM VIEW HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:PALM VIEW HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HULLIHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-583-4878
Mailing Address - Street 1:15267 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7727
Mailing Address - Country:US
Mailing Address - Phone:928-583-4878
Mailing Address - Fax:
Practice Address - Street 1:1616 N LITCHFIELD RD STE A220
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1252
Practice Address - Country:US
Practice Address - Phone:928-583-4878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)