=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194526285
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | E4RTH ALLIED HEALTH &WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2025
-----------------------------------------------------
Last Update Date | 06/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4182 WORTH AVE SPC L-115
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43219-1535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-305-5124
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2606 HILLIARD ROME RD # V124
-----------------------------------------------------
City | HILLIARD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43026-9468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-305-5124
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO, FOUNDER, AND WELLNESS DIRECTOR
-----------------------------------------------------
Name | MS. LATERRA DEMETRIA MARIE SLATE
-----------------------------------------------------
Credential | MPH, PBT/ MLT (ASCP)
-----------------------------------------------------
Telephone | 614-305-5124
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246RM2200X
-----------------------------------------------------
Taxonomy Name | Medical Laboratory Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QP0905X
-----------------------------------------------------
Taxonomy Name | State or Local Public Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 174H00000X
-----------------------------------------------------
Taxonomy Name | Health Educator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------