Provider Demographics
NPI:1457728487
Name:EELON WELLNESS AND MASSAGE
Entity type:Organization
Organization Name:EELON WELLNESS AND MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:RMP
Authorized Official - Phone:240-241-2490
Mailing Address - Street 1:3611 BRANCH AVE
Mailing Address - Street 2:#207
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1242
Mailing Address - Country:US
Mailing Address - Phone:352-314-0129
Mailing Address - Fax:
Practice Address - Street 1:6414 BEAR CT
Practice Address - Street 2:#207
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4301
Practice Address - Country:US
Practice Address - Phone:352-314-0129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR02162305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service