Healthcare Provider Details

I. General information

NPI: 1336004530
Provider Name (Legal Business Name): JEREMIAH 33:6 VIRTUAL HEALTH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 ROSEALEE AVE
ELYRIA OH
44035-2945
US

IV. Provider business mailing address

1065 ROSEALEE AVE
ELYRIA OH
44035-2945
US

V. Phone/Fax

Practice location:
  • Phone: 440-309-3823
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. CANDACE LEE BOLARINWA
Title or Position: OWNER
Credential: APRN-CNP
Phone: 440-309-3823