Provider Demographics
NPI:1669246450
Name:SURPRISE VALLEY HEALTH AND WELLNESS. INC
Entity type:Organization
Organization Name:SURPRISE VALLEY HEALTH AND WELLNESS. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN-ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:EMEGBAGHA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C, PMHNP-BC
Authorized Official - Phone:941-549-2765
Mailing Address - Street 1:417 SECURITY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1728
Mailing Address - Country:US
Mailing Address - Phone:941-549-2765
Mailing Address - Fax:719-888-7686
Practice Address - Street 1:1304 N ACADEMY BLVD STE 209
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3318
Practice Address - Country:US
Practice Address - Phone:719-888-7668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty