Provider Demographics
NPI:1831826817
Name:MAKE ME OVER WHOLISTIC HEALTH AND STRESS MANAGEMENT CENT LLC
Entity type:Organization
Organization Name:MAKE ME OVER WHOLISTIC HEALTH AND STRESS MANAGEMENT CENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSW, LMT
Authorized Official - Phone:513-888-3198
Mailing Address - Street 1:10979 REED HARTMAN HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-2857
Mailing Address - Country:US
Mailing Address - Phone:513-888-3198
Mailing Address - Fax:
Practice Address - Street 1:10979 REED HARTMAN HWY STE 100
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-2857
Practice Address - Country:US
Practice Address - Phone:513-888-3198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1982144390Medicaid