Provider Demographics
NPI:1538533013
Name:I WANT TO BE HEALTHY LLC
Entity type:Organization
Organization Name:I WANT TO BE HEALTHY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LUCHIA
Authorized Official - Middle Name:LYNNETTE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-964-4022
Mailing Address - Street 1:18247 N TOYA ST
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-2905
Mailing Address - Country:US
Mailing Address - Phone:832-964-4022
Mailing Address - Fax:347-960-4805
Practice Address - Street 1:18247 N TOYA ST
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-2905
Practice Address - Country:US
Practice Address - Phone:832-964-4022
Practice Address - Fax:347-960-4805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363LP0808X, 363LF0000X
AZAP3446363LF0000X
AZAP5602363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ184231OtherMEDICARE PTAN