# EARTH REMEDY OPTIMAL WELLNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Soul Journey Bliss Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043092257
- **Authorized official:** UBUNIBI-AFIA AGBENYAGA SHORT DIVINE (OWNER)
- **Authorized official phone:** (423) 880-3621

## Contact information

- **Practice address:** 417 GREENLEE RD, JOHNSON CITY, TN 37601-7064
- **Practice address phone:** (423) 302-0205
- **Practice address fax:** (423) 220-8582
- **Mailing address:** 417 GREENLEE RD, JOHNSON CITY, TN 37601-7064
- **Mailing address phone:** (423) 302-0205
- **Mailing address fax:** (423) 220-8285

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171400000X | Health & Wellness Coach | — | NULL | Yes |
| 171400000X | Health & Wellness Coach | — | — | Yes |
| 172V00000X | Community Health Worker | — | NULL | — |
| 172V00000X | Community Health Worker | — | — | — |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |

## Other

- **Enumeration date:** 10/23/2023
- **Last updated:** 10/23/2023