Provider Demographics
NPI:1801669478
Name:ABUNDANT LIFE TOTAL WELLNESS LLC
Entity type:Organization
Organization Name:ABUNDANT LIFE TOTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SYBIL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-592-3010
Mailing Address - Street 1:2581 COLTS NECK RD
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9649
Mailing Address - Country:US
Mailing Address - Phone:614-592-3010
Mailing Address - Fax:
Practice Address - Street 1:4200 REGENT ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6229
Practice Address - Country:US
Practice Address - Phone:877-868-8777
Practice Address - Fax:740-365-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty