Provider Demographics
NPI:1265910442
Name:EPIC HEALTHCARE AND WELLNESS SOLUTIONS LLC
Entity type:Organization
Organization Name:EPIC HEALTHCARE AND WELLNESS SOLUTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:636-789-1499
Mailing Address - Street 1:1551 WALL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-3539
Mailing Address - Country:US
Mailing Address - Phone:636-789-1499
Mailing Address - Fax:310-929-2597
Practice Address - Street 1:4919 JAMESTOWNE RIDGE CT
Practice Address - Street 2:
Practice Address - City:BLACK JACK
Practice Address - State:MO
Practice Address - Zip Code:63033-4554
Practice Address - Country:US
Practice Address - Phone:314-269-7868
Practice Address - Fax:310-929-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2017003919251J00000X
261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No251J00000XAgenciesNursing Care