| Koroma Family Wellness Llc | |
|
1457 W Southern Ave Ste A3 Mesa AZ 85202-4813 | |
| (602) 838-9434 | |
| Not Available |
| Full Name | Koroma Family Wellness Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1457 W Southern Ave Ste A3, Mesa, Arizona |
| Authorized Official Name and Position | Audrey Pope (OWNER) |
| Authorized Official Contact | 2145774850 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Koroma Family Wellness Llc 1457 W Southern Ave Ste A3 Mesa AZ 85202-4813 Ph: (602) 838-9434 | Koroma Family Wellness Llc 1457 W Southern Ave Ste A3 Mesa AZ 85202-4813 Ph: (602) 838-9434 |
| NPI Number | 1245936301 |
|---|---|
| Provider Enumeration Date | 01/31/2023 |
| Last Update Date | 06/13/2024 |
| Certification Date | 06/13/2024 |
| Medicare PECOS PAC ID | 7113392325 |
|---|---|
| Medicare Enrollment ID | O20230331000237 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245936301 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Adebukola Y Aladesanmi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568179877 PECOS PAC ID: 6608247978 Enrollment ID: I20230124002372 |
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