Provider Demographics
NPI:1669166617
Name:CHANDLER WELLNESS HOUSE LLC
Entity type:Organization
Organization Name:CHANDLER WELLNESS HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:602-526-6811
Mailing Address - Street 1:1057 N MONTEREY ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-2653
Mailing Address - Country:US
Mailing Address - Phone:602-526-6811
Mailing Address - Fax:
Practice Address - Street 1:1988 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7078
Practice Address - Country:US
Practice Address - Phone:602-526-6811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities