Provider Demographics
NPI:1891498812
Name:JUST BREATHE WELLNESS AND HEALING CENTER LLC
Entity Type:Organization
Organization Name:JUST BREATHE WELLNESS AND HEALING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANJARRES
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:305-281-0789
Mailing Address - Street 1:1050 SHILOH RD NW STE 310
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-8100
Mailing Address - Country:US
Mailing Address - Phone:470-523-9422
Mailing Address - Fax:470-523-9432
Practice Address - Street 1:1050 SHILOH RD NW STE 310
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-8100
Practice Address - Country:US
Practice Address - Phone:470-523-9422
Practice Address - Fax:470-523-9432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty