Provider Demographics
NPI:1336664457
Name:RAJA WELLNESS, LLC
Entity Type:Organization
Organization Name:RAJA WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNYMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:270-506-3853
Mailing Address - Street 1:3044 RING RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7932
Mailing Address - Country:US
Mailing Address - Phone:270-681-5074
Mailing Address - Fax:855-290-1817
Practice Address - Street 1:3044 RING RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7932
Practice Address - Country:US
Practice Address - Phone:270-681-5074
Practice Address - Fax:855-290-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-09
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 225700000X
KYAC086171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty