Provider Demographics
NPI:1194935387
Name:HEART AND WELLNESS INSTITUTE
Entity type:Organization
Organization Name:HEART AND WELLNESS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN / OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MSM
Authorized Official - Phone:616-719-5939
Mailing Address - Street 1:5043 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3724
Mailing Address - Country:US
Mailing Address - Phone:616-719-5939
Mailing Address - Fax:616-719-5933
Practice Address - Street 1:5043 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3724
Practice Address - Country:US
Practice Address - Phone:616-719-5939
Practice Address - Fax:616-719-5933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080691174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5199674Medicaid
1194935387OtherUNITED HEALTHCARE
DG1222OtherRR / RAILROAD MEDICARE
MI060D120890OtherBLUE CROSS BLUE SHIELD
0P46910OtherCOFINITY / PPOM
DG1222OtherRR / RAILROAD MEDICARE