Healthcare Provider Details

I. General information

NPI: 1194526285
Provider Name (Legal Business Name): E4RTH ALLIED HEALTH &WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 06/08/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4182 WORTH AVE SPC L-115
COLUMBUS OH
43219-1535
US

IV. Provider business mailing address

2606 HILLIARD ROME RD # V124
HILLIARD OH
43026-9468
US

V. Phone/Fax

Practice location:
  • Phone: 614-305-5124
  • Fax:
Mailing address:
  • Phone: 614-305-5124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LATERRA DEMETRIA MARIE SLATE
Title or Position: CEO, FOUNDER, AND WELLNESS DIRECTOR
Credential: MPH, PBT/ MLT (ASCP)
Phone: 614-305-5124