Healthcare Provider Details

I. General information

NPI: 1861292963
Provider Name (Legal Business Name): SOS WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6730 ROOSEVELT AVE STE 301
MIDDLETOWN OH
45005-5736
US

IV. Provider business mailing address

6730 ROOSEVELT AVE STE 301
MIDDLETOWN OH
45005-5736
US

V. Phone/Fax

Practice location:
  • Phone: 440-523-9966
  • Fax: 513-318-7388
Mailing address:
  • Phone: 440-523-9966
  • Fax: 513-318-7388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY JARRELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 440-523-9966