Organization
LIFE CHANGING WELLNESS & TREATMENT CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIO BUSTOS (CEO)
(702) 418-6930
Entity
Organization
Contact information
Practice address
4831 N 35TH AVE, PHOENIX, AZ 85017-3011
(702) 418-6930
Mailing address
4831 N 35TH AVE, PHOENIX, AZ 85017-3011
(702) 418-6930
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/23/2022
Last updated
08/23/2022
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