Organization · NPI-2
Earth Remedy Optimal Wellness LLC
Health & Wellness Coach · Johnson City, TN
NPI number1043092257
StatusActive
Last updated in NPPESOct 23, 2023
Details
- NPI
- 1043092257
- Entity type
- Organization (NPI-2)
- Legal business name
- Earth Remedy Optimal Wellness LLC
- Organization subpart
- No
- Enumeration date
- Oct 23, 2023
- Certification date
- Oct 21, 2023
- Last updated
- Oct 23, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 171400000X | Health & Wellness Coach | – | – | Yes |
| 172V00000X | Community Health Worker | – | – | |
| 332BC3200X | Durable Medical Equipment & Medical Supplies, Customized Equipment | – | – |
Other names
- Soul Journey Bliss Center (Doing Business As)
Practice location
417 Greenlee RdJohnson City, TN 37601-7064
Phone 423-302-0205 · Fax 423-220-8582
Mailing address
417 Greenlee RdJohnson City, TN 37601-7064
Phone 423-302-0205 · Fax 423-220-8285
Authorized official
Ubunibi-Afia Agbenyaga Short
Owner
4238803621
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.