Organization
EARTH REMEDY OPTIMAL WELLNESS LLC
Active
Other names
Soul Journey Bliss Center
Organization subpart
No
Provider details
NPI number
Authorized official
UBUNIBI-AFIA AGBENYAGA SHORT DIVINE (OWNER)
(423) 880-3621
Entity
Organization
Contact information
Practice address
417 GREENLEE RD, JOHNSON CITY, TN 37601-7064
(423) 302-0205
(423) 220-8582
Mailing address
417 GREENLEE RD, JOHNSON CITY, TN 37601-7064
(423) 302-0205
(423) 220-8285
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
Primary
—
—
172V00000X
Community Health Worker
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
10/23/2023
Last updated
10/23/2023
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