Provider Demographics
NPI:1790502144
Name:BODHI LLC
Entity type:Organization
Organization Name:BODHI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MARTIS VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:787-244-9451
Mailing Address - Street 1:URB. EL PLANTIO
Mailing Address - Street 2:CALLE JACANA G19F
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-244-9451
Mailing Address - Fax:
Practice Address - Street 1:BODHI LLC
Practice Address - Street 2:CARRETERA #2 KM 16.8 CANDELARIA
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-244-9451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty