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General NPI Number Information
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NPI Number | 1700525961
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Entity Type | Organization
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Legal Business Name | VESSEL: BODHI MIND AND SOUL LLC
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Dates
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Enumeration Date | 06/03/2022
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 1805 DUNN BROOK RD
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City | BOONVILLE
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State | NY
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Zip | 13309-4219
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Country | US
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Telephone | 315-527-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 1805 DUNN BROOK RD
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City | BOONVILLE
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State | NY
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Zip | 13309-4219
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Country | US
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Telephone | 315-527-8300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINA E HENRY
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Credential | RN
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Telephone | 315-527-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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