Provider Demographics
NPI:1871816520
Name:BLUE ROSE HOLISTICS, LLC
Entity Type:Organization
Organization Name:BLUE ROSE HOLISTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MITCHELL-LEE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:304-532-5412
Mailing Address - Street 1:101 COURT ST N
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-1207
Mailing Address - Country:US
Mailing Address - Phone:304-532-5412
Mailing Address - Fax:
Practice Address - Street 1:101 COURT ST N
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-1207
Practice Address - Country:US
Practice Address - Phone:304-532-5412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Single Specialty