MEDICARE: HEALING WOUNDS COLLECTIVE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1811785934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING WOUNDS COLLECTIVE LLC

Provider Business Mailing Address
First Line	:	2850 S ARLINGTON RD STE 102
Second Line	:
City	:	COVENTRY TOWNSHIP
State	:	OH
Zip	:	44312-4719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 S ARLINGTON RD STE 102
Second Line	:
City	:	COVENTRY TOWNSHIP
State	:	OH
Zip	:	44312-4719
Country	:	US
Telephone Number	:	330-319-3361
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	TIARA BROADY
Credential	:	APRN
Telephone Number	:	330-319-3361

Provider Enumeration Date	:	04/28/2025
Last Update Date	:	04/28/2025

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