Provider Demographics
NPI:1124661525
Name:MIND AND BODY INFUSION THERAPIES, LLC
Entity type:Organization
Organization Name:MIND AND BODY INFUSION THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANGUS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:216-392-6088
Mailing Address - Street 1:9264 CHILLICOTHE RD.
Mailing Address - Street 2:UNIT #2
Mailing Address - City:KIRTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44094
Mailing Address - Country:US
Mailing Address - Phone:216-392-6088
Mailing Address - Fax:
Practice Address - Street 1:9264 CHILLICOTHE RD.
Practice Address - Street 2:UNIT #2
Practice Address - City:KIRTLAND
Practice Address - State:OH
Practice Address - Zip Code:44094
Practice Address - Country:US
Practice Address - Phone:216-392-6088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy