=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225725815
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE MORE DAY WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2023
-----------------------------------------------------
Last Update Date | 04/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6315 PEARL RD STE 305
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44130-3074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-273-6888
-----------------------------------------------------
Fax | 216-273-6888
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6315 PEARL RD STE 305
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44130-3074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-273-6888
-----------------------------------------------------
Fax | 216-273-6888
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | NICOLE D NICKENS
-----------------------------------------------------
Credential | MSN APRN AGNP-C
-----------------------------------------------------
Telephone | 216-273-6888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------