Provider Demographics
NPI:1043929078
Name:AMARIS JEAN AESTHETICS AND WELLNESS LLC
Entity type:Organization
Organization Name:AMARIS JEAN AESTHETICS AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/CNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KETURA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:216-855-7775
Mailing Address - Street 1:13512 THORNHURST AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6851
Mailing Address - Country:US
Mailing Address - Phone:216-855-7775
Mailing Address - Fax:
Practice Address - Street 1:4630 RICHMOND RD STE 198
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5954
Practice Address - Country:US
Practice Address - Phone:216-855-7775
Practice Address - Fax:216-245-6126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care