| Organization Name: | GRAND COUNTY WELLNESS CENTER |
| NPI Number: | 1164586954 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RAY ALLEN ANDREW (OWNER) |
| Mailing Address: | 255 Williams Way Moab |
| State: | UT US |
| Postal Code: | 845322370 |
| Phone Number: | 4352594466 |
| Fax Number: | 4352594467 |
| NPI Enumeration Date: | 12/19/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |