Organization
GRANDE INTEGRATED WELLNESS SOLUTIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WINSTON ONYEANI (OWNER)
(404) 447-0127
Entity
Organization
Contact information
Practice address
5201 N 19TH AVE, PHOENIX, AZ 85015-2951
(404) 447-0127
Mailing address
5201 N 19TH AVE, PHOENIX, AZ 85015-2951
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Enumeration date
08/13/2024
Last updated
09/05/2024
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