Provider Demographics
NPI:1518515972
Name:BODYMIND ALCHEMY LLC
Entity type:Organization
Organization Name:BODYMIND ALCHEMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, NTP
Authorized Official - Phone:612-203-2872
Mailing Address - Street 1:2640 ULYSSES ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-3048
Mailing Address - Country:US
Mailing Address - Phone:612-203-2872
Mailing Address - Fax:
Practice Address - Street 1:2233 HAMLINE AVE N STE 433
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-5006
Practice Address - Country:US
Practice Address - Phone:651-600-6181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service