Provider Demographics
NPI:1881107795
Name:WELLNESS GARDEN
Entity type:Organization
Organization Name:WELLNESS GARDEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLDFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM
Authorized Official - Phone:509-888-7370
Mailing Address - Street 1:PO BOX 2308
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-2308
Mailing Address - Country:US
Mailing Address - Phone:509-888-7370
Mailing Address - Fax:
Practice Address - Street 1:2205 W WOODIN AVE
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-9310
Practice Address - Country:US
Practice Address - Phone:509-888-7370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty