Provider Demographics
NPI:1568040723
Name:SAHARA WELLNESS CENTER LLC
Entity type:Organization
Organization Name:SAHARA WELLNESS CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GURMINDER (SIMI)
Authorized Official - Middle Name:
Authorized Official - Last Name:PUREWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-878-2100
Mailing Address - Street 1:6677 W THUNDERBIRD RD STE I164
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5720 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-1420
Practice Address - Country:US
Practice Address - Phone:602-790-0070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAHARA WELLNESS CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-30
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC13468OtherARIZONA DEPARTMENT OF HEALTH SERVICES