Integrated Wellness Center LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

INTEGRATED WELLNESS CENTER LLC

Practice address

2316 W Northern Ave
Phoenix, AZ 85021-4935

Phone

(602) 838-7799

Fax

(602) 844-2525

NPI assigned

May 26, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ravikulasingham Thuraisingam

Title

Administrator

Phone

(650) 847-8861

Specialties & licenses 3

Addresses

Other names 1

• RT Builders LLC Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685404800000",
    "number": "1760175723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5523 S JOLLY ROGER RD",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852832118",
            "telephone_number": "650-847-8861",
            "fax_number": "602-844-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2316 W NORTHERN AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850214935",
            "telephone_number": "602-838-7799",
            "fax_number": "602-844-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-26",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A",
        "authorized_official_last_name": "THURAISINGAM",
        "authorized_official_first_name": "RAVIKULASINGHAM",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "650-847-8861"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RT Builders LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Health Service Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Health Service Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.