Provider Demographics
NPI:1710408448
Name:ULTIMATE WELLNESS PROVIDERS CO
Entity type:Organization
Organization Name:ULTIMATE WELLNESS PROVIDERS CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:CCMA
Authorized Official - Phone:877-768-4897
Mailing Address - Street 1:1880 S DAIRY ASHFORD RD STE 207-439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-4760
Mailing Address - Country:US
Mailing Address - Phone:877-768-4897
Mailing Address - Fax:
Practice Address - Street 1:1880 S DAIRY ASHFORD RD STE 207-439
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-4760
Practice Address - Country:US
Practice Address - Phone:877-768-4897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-03
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174200000X, 177F00000X, 251B00000X, 251C00000X, 251E00000X, 251F00000X, 251J00000X, 251V00000X, 252Y00000X, 253Z00000X, 261Q00000X, 261QA0600X, 261QC1800X, 261QH0100X
LA261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No251V00000XAgenciesVoluntary or Charitable
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1366970394OtherHOME HEALTH CARE SERVICES
TX1366970394Medicaid
LA1366970394Medicaid
LA1366970394OtherHOME HEALTH CARE SERVICES