Provider Demographics
NPI:1659069995
Name:EVERLAST WELLNESS GROUP LLC
Entity Type:Organization
Organization Name:EVERLAST WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CATELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-501-6137
Mailing Address - Street 1:8124 SANDY SLOPE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8124 SANDY SLOPE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4436
Practice Address - Country:US
Practice Address - Phone:702-501-6137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care