Provider Demographics
NPI:1497367056
Name:MODERN HEALTH EXPERIENCE LLC
Entity Type:Organization
Organization Name:MODERN HEALTH EXPERIENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-690-4986
Mailing Address - Street 1:920 CAUDLE LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TX
Mailing Address - Zip Code:76227-7873
Mailing Address - Country:US
Mailing Address - Phone:214-690-4986
Mailing Address - Fax:
Practice Address - Street 1:920 CAUDLE LN
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TX
Practice Address - Zip Code:76227-7873
Practice Address - Country:US
Practice Address - Phone:214-690-4986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MODERN HEALTH EXPERIENCE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty