Provider Demographics
NPI:1588366777
Name:ESSENTIAL HEALTH AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:ESSENTIAL HEALTH AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-831-3057
Mailing Address - Street 1:4515 S MCCLINTOCK DR STE 209
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7382
Mailing Address - Country:US
Mailing Address - Phone:480-831-3057
Mailing Address - Fax:
Practice Address - Street 1:4515 S MCCLINTOCK DR STE 209
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7382
Practice Address - Country:US
Practice Address - Phone:480-831-3057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health