Healthcare Provider Details

I. General information

NPI: 1386092757
Provider Name (Legal Business Name): LIMESTONE WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9323 SCOT ST
HUDSON FL
34669-1961
US

IV. Provider business mailing address

9323 SCOT ST
HUDSON FL
34669-1961
US

V. Phone/Fax

Practice location:
  • Phone: 770-314-5172
  • Fax:
Mailing address:
  • Phone: 770-314-5172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHEYENNE ELIZABETH WHISENANT
Title or Position: PRESIDENT
Credential: M.S.
Phone: 770-314-5172