Provider Demographics
NPI:1104540178
Name:MADE WHOLE TELEHEALTH & CONCIERGE SERVICES, LLC
Entity type:Organization
Organization Name:MADE WHOLE TELEHEALTH & CONCIERGE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/FNP
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:281-989-3319
Mailing Address - Street 1:PO BOX 1345
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-0011
Mailing Address - Country:US
Mailing Address - Phone:281-989-3319
Mailing Address - Fax:888-616-0348
Practice Address - Street 1:111 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501-7628
Practice Address - Country:US
Practice Address - Phone:281-989-3319
Practice Address - Fax:888-616-0348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health