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General NPI Number Information
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NPI Number | 1104700111
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Entity Type | Organization
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Legal Business Name | HEALING MANTLE, LLC
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 5117 JACKS BLVD
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City | CHAMPAIGN
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State | IL
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Zip | 61822-3656
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Country | US
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Telephone | 217-318-1860
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Fax |
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Provider Business Mailing Address
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Address Line | 5117 JACKS BLVD
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City | CHAMPAIGN
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State | IL
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Zip | 61822-3656
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Country | US
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Telephone | 217-318-1860
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | INA MEDINA WILLIAMS
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Credential | RN
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Telephone | 217-318-1860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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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 | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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