Provider Demographics
NPI:1336986165
Name:TWO WORLDS WELLNESS LLC
Entity type:Organization
Organization Name:TWO WORLDS WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CONTROLLER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:ELIZABETH ESTEVA
Authorized Official - Last Name:SLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:734-255-6706
Mailing Address - Street 1:2800 S STATE ST STE 215
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-7103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2800 S STATE ST STE 215
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-7103
Practice Address - Country:US
Practice Address - Phone:734-547-3990
Practice Address - Fax:734-547-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-10
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service