Organization
MADE WHOLE MEDICAL CENTER LLC
Active
Parent organization
CLINICAL
Other names
MADE WHOLE MEDICAL CENTER LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CLINICAL
Authorized official
CAREMLA J BANKS (OWNER)
(623) 300-6457
Entity
Organization
Contact information
Practice address
13048 W RANCHO SANTA FE BLVD, AVONDALE, AZ 85392-1705
(623) 300-6457
(855) 300-5330
Mailing address
13048 W RANCHO SANTA FE BLVD, AVONDALE, AZ 85392-1705
(623) 300-6457
(855) 300-5330
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
—
—
251B00000X
Case Management Agency
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QF0050X
Non-Surgical Family Planning Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2400X
Prison Health Clinic/Center
—
—
261QV0200X
VA Clinic/Center
—
—
Other
Enumeration date
10/09/2023
Last updated
10/21/2023
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