Provider Demographics
NPI:1427884675
Name:HEALING EDGE RECOVERY AND WELLNESS CENTER
Entity type:Organization
Organization Name:HEALING EDGE RECOVERY AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:KAMALJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-753-5544
Mailing Address - Street 1:4220 N 20TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-5124
Mailing Address - Country:US
Mailing Address - Phone:602-753-5544
Mailing Address - Fax:
Practice Address - Street 1:4220 N 20TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-5124
Practice Address - Country:US
Practice Address - Phone:602-753-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services