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General NPI Number Information
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NPI Number | 1104540178
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Entity Type | Organization
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Legal Business Name | MADE WHOLE TELEHEALTH & CONCIERGE SERVICES, LLC
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 111 W CENTRAL AVE
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City | TEMPLE
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State | TX
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Zip | 76501-7628
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Country | US
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Telephone | 281-989-3319
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Fax | 888-616-0348
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Provider Business Mailing Address
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Address Line | PO BOX 1345
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City | LAMPASAS
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State | TX
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Zip | 76550-0011
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Country | US
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Telephone | 281-989-3319
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Fax | 888-616-0348
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Authorized Official
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Title or Position | CEO/FNP
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Name | CHANDRA CRAVENS
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Credential | FNP
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Telephone | 281-989-3319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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