Provider Demographics
NPI:1649958927
Name:SALTWATER INTEGRATIVE WELLNESS, LLC
Entity type:Organization
Organization Name:SALTWATER INTEGRATIVE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BECKLIN-TYNDALL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:302-841-4728
Mailing Address - Street 1:28467 DUPONT BLVD UNIT 6
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-3749
Mailing Address - Country:US
Mailing Address - Phone:302-272-9738
Mailing Address - Fax:866-371-4672
Practice Address - Street 1:28467 DUPONT BLVD UNIT 6
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-3749
Practice Address - Country:US
Practice Address - Phone:302-272-9738
Practice Address - Fax:866-371-4672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service