Provider Demographics
NPI:1639976012
Name:MAJESTIC WELLNESS CLINICS INC
Entity type:Organization
Organization Name:MAJESTIC WELLNESS CLINICS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C E O
Authorized Official - Prefix:
Authorized Official - First Name:SHAFIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKOOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-689-6958
Mailing Address - Street 1:1515 E FLORENCE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5334
Mailing Address - Country:US
Mailing Address - Phone:800-689-6958
Mailing Address - Fax:
Practice Address - Street 1:1515 E FLORENCE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5334
Practice Address - Country:US
Practice Address - Phone:323-251-7313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-25
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)