Earth Remedy Optimal Wellness LLC

Primary specialty

Health & Wellness CoachTaxonomy code 171400000X

Legal business name

EARTH REMEDY OPTIMAL WELLNESS LLC

Practice address

417 Greenlee Rd
Johnson City, TN 37601-7064

Phone

(423) 302-0205

Fax

(423) 220-8582

NPI assigned

Oct 23, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ubunibi-Afia Agbenyaga Short, DIVINE

Title

Owner

Phone

(423) 880-3621

Specialties & licenses 3

Addresses

Other names 1

• Soul Journey Bliss Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698019200000",
    "number": "1043092257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 GREENLEE RD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376017064",
            "telephone_number": "423-302-0205",
            "fax_number": "423-220-8285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 GREENLEE RD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376017064",
            "telephone_number": "423-302-0205",
            "fax_number": "423-220-8582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EARTH REMEDY OPTIMAL WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-23",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-21",
        "status": "A",
        "authorized_official_last_name": "SHORT",
        "authorized_official_first_name": "UBUNIBI-AFIA",
        "authorized_official_middle_name": "AGBENYAGA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-880-3621",
        "authorized_official_credential": "DIVINE"
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Soul Journey Bliss Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Health & Wellness Coach in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Health & Wellness Coach in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.