Provider Demographics
NPI:1265059497
Name:ATHOS WELLNESS LLC
Entity type:Organization
Organization Name:ATHOS WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELEFTHERAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC DIPL OM
Authorized Official - Phone:570-851-7023
Mailing Address - Street 1:1340 CHARLES RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18436-3415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1340 CHARLES RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18436-3415
Practice Address - Country:US
Practice Address - Phone:570-851-7023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-03
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service