Provider Demographics
NPI:1043934094
Name:WELLNESS BY GRATEFUL CARROT LLC
Entity type:Organization
Organization Name:WELLNESS BY GRATEFUL CARROT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:816-775-0755
Mailing Address - Street 1:3612 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64127-1503
Mailing Address - Country:US
Mailing Address - Phone:913-909-1221
Mailing Address - Fax:
Practice Address - Street 1:3612 E 10TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64127-1503
Practice Address - Country:US
Practice Address - Phone:913-909-1221
Practice Address - Fax:
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
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service