Provider Demographics
NPI:1497516462
Name:MANIFEST HOLISTIC CENTRE, LLC
Entity Type:Organization
Organization Name:MANIFEST HOLISTIC CENTRE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEALIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-209-3440
Mailing Address - Street 1:17800 CHILLICOTHE RD STE 240
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4886
Mailing Address - Country:US
Mailing Address - Phone:440-384-3196
Mailing Address - Fax:
Practice Address - Street 1:17800 CHILLICOTHE RD STE 240
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-4886
Practice Address - Country:US
Practice Address - Phone:440-384-3196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
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No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty