Provider Demographics
NPI:1851169510
Name:EQUILIBRIUM WELLNESS CARE, LLC
Entity Type:Organization
Organization Name:EQUILIBRIUM WELLNESS CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRIPLET
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:772-448-4456
Mailing Address - Street 1:850 S 21ST ST STE B
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4829
Mailing Address - Country:US
Mailing Address - Phone:772-448-4456
Mailing Address - Fax:772-448-4674
Practice Address - Street 1:850 S 21ST ST STE B
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4829
Practice Address - Country:US
Practice Address - Phone:772-448-4456
Practice Address - Fax:772-448-4674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center