Provider Demographics
NPI:1558190256
Name:I AM WELLNESS AZ LLC
Entity type:Organization
Organization Name:I AM WELLNESS AZ LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, GOVERNMENT PROGRAMS
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RATNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-900-9355
Mailing Address - Street 1:898 N 1200 W STE 201
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-3558
Mailing Address - Country:US
Mailing Address - Phone:385-499-5349
Mailing Address - Fax:
Practice Address - Street 1:3400 GRAND AVE STE 112
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-4507
Practice Address - Country:US
Practice Address - Phone:480-900-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:I AM WELLNESS AZ LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-31
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care