| Obsidian Health And Wellness Llc | |
|
13321 W Indian School Rd Litchfield Park AZ 85340-4339 | |
| (000) 000-0000 | |
| Not Available |
| Full Name | Obsidian Health And Wellness Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 13321 W Indian School Rd, Litchfield Park, Arizona |
| Authorized Official Name and Position | Jennifer Flack (DIRECTOR OF CLINICAL SERVICES) |
| Authorized Official Contact | 7203311168 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Obsidian Health And Wellness Llc 13321 W Indian School Rd Ste A107 Litchfield Park AZ 85340-4339 Ph: (602) 550-7844 | Obsidian Health And Wellness Llc 13321 W Indian School Rd Litchfield Park AZ 85340-4339 Ph: (000) 000-0000 |
| NPI Number | 1740766237 |
|---|---|
| Provider Enumeration Date | 07/17/2018 |
| Last Update Date | 09/28/2018 |
| Medicare PECOS PAC ID | 8224380456 |
|---|---|
| Medicare Enrollment ID | O20181016002240 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740766237 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jennifer L Flack |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760920789 PECOS PAC ID: 9133471360 Enrollment ID: I20181029001035 |
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