1811223704 NPI number — WELLNESS HORIZONS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811223704 NPI number — WELLNESS HORIZONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLNESS HORIZONS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DIABETES HEALTH SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811223704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89803-0016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-777-9355
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
239 FLORA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING CREEK
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89815-5126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-777-9355
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOYER
Authorized Official First Name:
JAN
Authorized Official Middle Name:
LIENKE
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
775-738-9464

Provider Taxonomy Codes

  • Taxonomy code: 364SM0705X , with the licence number:  RN52119 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)