Provider Demographics
NPI:1386299675
Name:BALANCE & WELLBEING, LLC
Entity type:Organization
Organization Name:BALANCE & WELLBEING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROQUEZA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:630-344-9617
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-0699
Mailing Address - Country:US
Mailing Address - Phone:360-903-1829
Mailing Address - Fax:360-991-0337
Practice Address - Street 1:1051 PERIMETER DR STE 1100
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5079
Practice Address - Country:US
Practice Address - Phone:630-344-9617
Practice Address - Fax:847-648-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10029352OtherOREGON BOARD OF NURSING
WAAP61586857OtherWASHINGTON BOARD OF NURSING