Healthcare Provider Details

I. General information

NPI: 1740157312
Provider Name (Legal Business Name): 521 WELLNESS AND TRAINING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 LAKE AVE
ASHTABULA OH
44004-3262
US

IV. Provider business mailing address

2285 FORMAN RD
JEFFERSON OH
44047-9614
US

V. Phone/Fax

Practice location:
  • Phone: 440-812-9126
  • Fax:
Mailing address:
  • Phone: 440-812-9126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIANA BUCHER
Title or Position: OWNER/NURSE PRACTITIONER
Credential: CNP
Phone: 440-812-9126