Provider Demographics
NPI:1790417772
Name:WELLNESS CUBE LLC
Entity Type:Organization
Organization Name:WELLNESS CUBE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GABOUREL-ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-262-0916
Mailing Address - Street 1:9131 PISCATAWAY RD STE 150
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2510
Mailing Address - Country:US
Mailing Address - Phone:202-365-1120
Mailing Address - Fax:
Practice Address - Street 1:9131 PISCATAWAY RD STE 150
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2510
Practice Address - Country:US
Practice Address - Phone:202-365-1120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care