Provider Demographics
NPI:1497503395
Name:MASHKIKI WELLNESS LLC
Entity type:Organization
Organization Name:MASHKIKI WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ZASTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-421-8715
Mailing Address - Street 1:PO BOX 1945
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-1945
Mailing Address - Country:US
Mailing Address - Phone:701-421-8715
Mailing Address - Fax:
Practice Address - Street 1:4489 HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316
Practice Address - Country:US
Practice Address - Phone:701-421-8715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty