Provider Demographics
NPI:1275133431
Name:ECHELON PREMIUM HEALTH LLC
Entity Type:Organization
Organization Name:ECHELON PREMIUM HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDINE
Authorized Official - Middle Name:ROWENA
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP,DNP
Authorized Official - Phone:772-626-1002
Mailing Address - Street 1:4574 SW TABOR ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6740
Mailing Address - Country:US
Mailing Address - Phone:772-626-1002
Mailing Address - Fax:
Practice Address - Street 1:4574 SW TABOR ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-6740
Practice Address - Country:US
Practice Address - Phone:772-626-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty