Provider Demographics
NPI:1124448998
Name:UNITED WELLNESS GROUP LP
Entity type:Organization
Organization Name:UNITED WELLNESS GROUP LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF WELLNESS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUSHERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-867-4115
Mailing Address - Street 1:1001 WEST LOOP S
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-9084
Mailing Address - Country:US
Mailing Address - Phone:877-899-8996
Mailing Address - Fax:
Practice Address - Street 1:1001 WEST LOOP S
Practice Address - Street 2:SUITE 850
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-9084
Practice Address - Country:US
Practice Address - Phone:877-899-8996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTUS WELLNESS GROUP LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX#DT83193133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty