Healthcare Provider Details

I. General information

NPI: 1619543014
Provider Name (Legal Business Name): BALANCED HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 NEW EASLEY HWY
GREENVILLE SC
29611-7137
US

IV. Provider business mailing address

3302 NEW EASLEY HWY
GREENVILLE SC
29611-7137
US

V. Phone/Fax

Practice location:
  • Phone: 864-243-8158
  • Fax:
Mailing address:
  • Phone: 864-243-8158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: SHARON HOPE WILSON
Title or Position: CO-OWNER AND PROVIDER
Credential: APRN
Phone: 864-243-8158