Provider Demographics
NPI:1225785140
Name:BODY & MIND HEALTHCARE LLC
Entity Type:Organization
Organization Name:BODY & MIND HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:MESSERET
Authorized Official - Middle Name:MEHARI
Authorized Official - Last Name:TEWOLDE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:614-512-6994
Mailing Address - Street 1:2199 KILLDEER PL
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:OH
Mailing Address - Zip Code:43021-1502
Mailing Address - Country:US
Mailing Address - Phone:614-512-6994
Mailing Address - Fax:
Practice Address - Street 1:2199 KILLDEER PL
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:OH
Practice Address - Zip Code:43021-1502
Practice Address - Country:US
Practice Address - Phone:614-512-6994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care