Provider Demographics
NPI:1881443422
Name:ELIA HEALTH & WELLNESS INC
Entity type:Organization
Organization Name:ELIA HEALTH & WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA-C, CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BREANA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:COVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:805-427-4231
Mailing Address - Street 1:2185 BIRCHDALE DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1534
Mailing Address - Country:US
Mailing Address - Phone:805-427-4231
Mailing Address - Fax:
Practice Address - Street 1:6316 TOPANGA CANYON BLVD UNIT 406
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2288
Practice Address - Country:US
Practice Address - Phone:805-427-4231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service