Healthcare Provider Details

I. General information

NPI: 1629520069
Provider Name (Legal Business Name): A HEALING EXPERIENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5911 WILLOWS BRIDGE LOOP
ELLENTON FL
34222-5218
US

IV. Provider business mailing address

5911 WILLOWS BRIDGE LOOP
ELLENTON FL
34222-5218
US

V. Phone/Fax

Practice location:
  • Phone: 941-704-8326
  • Fax:
Mailing address:
  • Phone: 941-704-8326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: JOHN C WESTER SR.
Title or Position: OWNER/ MASSAGE THERAPIST
Credential: LMT
Phone: 941-704-8326