Provider Demographics
NPI:1528845757
Name:PREVENTIONONLYLLC
Entity type:Organization
Organization Name:PREVENTIONONLYLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:SANEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKRAVARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:833-767-8478
Mailing Address - Street 1:6521 BLACKFRIARS LN
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-3553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6521 BLACKFRIARS LN
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-3553
Practice Address - Country:US
Practice Address - Phone:833-767-8478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service