Provider Demographics
NPI:1801542618
Name:BODY AND SOUL HEALTH CENTER A PROFESSIONAL NURSING CORPORATION
Entity type:Organization
Organization Name:BODY AND SOUL HEALTH CENTER A PROFESSIONAL NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHABANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:951-496-5238
Mailing Address - Street 1:1240 E ONTARIO AVE # 102-103
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8671
Mailing Address - Country:US
Mailing Address - Phone:951-496-5238
Mailing Address - Fax:
Practice Address - Street 1:1101 CALIFORNIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-6472
Practice Address - Country:US
Practice Address - Phone:951-496-5238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty