| NPI | 1972273282 |
|---|---|
| Doing Business As | LIFESTYLE REDESIGN 77 |
| Doing Business As | EMERALD WELLNESS |
| Entity Type | Organization |
| Authorized Contact | BRANDON DAVAR PERVIS Vice President Of Clinical Operatio 203-957-3938 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2021-09-17 |