| Grande Integrated Wellness Solutions Llc | |
|
4419 N 93rd Dr Phoenix AZ 85037-0803 | |
| (404) 447-0127 | |
| Not Available |
| Full Name | Grande Integrated Wellness Solutions Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4419 N 93rd Dr, Phoenix, Arizona |
| Authorized Official Name and Position | Winston Onyeani (CEO) |
| Authorized Official Contact | 4044470127 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grande Integrated Wellness Solutions Llc 4419 N 93rd Dr Phoenix AZ 85037-0803 Ph: () - | Grande Integrated Wellness Solutions Llc 4419 N 93rd Dr Phoenix AZ 85037-0803 Ph: (404) 447-0127 |
| NPI Number | 1992577555 |
|---|---|
| Provider Enumeration Date | 10/26/2023 |
| Last Update Date | 05/01/2024 |
| Certification Date | 05/01/2024 |
| Medicare PECOS PAC ID | 4183065584 |
|---|---|
| Medicare Enrollment ID | O20240516001967 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992577555 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Daud Biola Koleosho |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962093781 PECOS PAC ID: 4880001544 Enrollment ID: I20210324001387 |
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