Provider Demographics
NPI:1275184129
Name:EKG WELLNESS SERVICES LLC
Entity Type:Organization
Organization Name:EKG WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELLWOOD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:CROUSE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:412-996-9128
Mailing Address - Street 1:113 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-2620
Mailing Address - Country:US
Mailing Address - Phone:412-996-9128
Mailing Address - Fax:724-212-3595
Practice Address - Street 1:215 ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-2058
Practice Address - Country:US
Practice Address - Phone:412-423-5445
Practice Address - Fax:724-212-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty