Provider Demographics
NPI:1730877184
Name:A1 WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:A1 WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHEEBA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MATHAI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-BC
Authorized Official - Phone:972-313-5017
Mailing Address - Street 1:3648 OLD DENTON RD STE 110D
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-7980
Mailing Address - Country:US
Mailing Address - Phone:972-313-5017
Mailing Address - Fax:214-387-1889
Practice Address - Street 1:3648 OLD DENTON RD STE 110D
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-7980
Practice Address - Country:US
Practice Address - Phone:972-313-5017
Practice Address - Fax:214-387-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty