Provider Demographics
NPI:1770464349
Name:HERITAGE WELLNESS, LLC
Entity type:Organization
Organization Name:HERITAGE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOUTE-EDOUARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-333-7017
Mailing Address - Street 1:13100 W DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-4131
Mailing Address - Country:US
Mailing Address - Phone:786-442-5021
Mailing Address - Fax:786-921-0041
Practice Address - Street 1:450 ALASKAN WAY S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3387
Practice Address - Country:US
Practice Address - Phone:786-442-5021
Practice Address - Fax:786-921-0041
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERITAGE WELLNESS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty