Healthcare Provider Details

I. General information

NPI: 1144893371
Provider Name (Legal Business Name): JASMINE PORCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2021
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 BELVOIR BLVD
SOUTH EUCLID OH
44121-1206
US

IV. Provider business mailing address

2380 BELVOIR BLVD
SOUTH EUCLID OH
44121-1206
US

V. Phone/Fax

Practice location:
  • Phone: 616-216-1202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberTE571593
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: