Provider Demographics
NPI:1720504111
Name:SOUTHWEST WELLNESS SOLUTIONS
Entity Type:Organization
Organization Name:SOUTHWEST WELLNESS SOLUTIONS
Other - Org Name:ST ELIZABETH FAMILY CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:FATTIGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-482-4535
Mailing Address - Street 1:PO BOX 1619
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-1619
Mailing Address - Country:US
Mailing Address - Phone:832-932-7900
Mailing Address - Fax:832-932-7901
Practice Address - Street 1:608 FM 517 RD W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539
Practice Address - Country:US
Practice Address - Phone:832-932-7900
Practice Address - Fax:832-932-7901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. ELIZABETH FAMILY CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-17
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty