Provider Demographics
NPI:1932848801
Name:ST. CHARLES WELLNESS CENTER
Entity Type:Organization
Organization Name:ST. CHARLES WELLNESS CENTER
Other - Org Name:ST. CHARLES WELLNESS CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ROSITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATILUS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP-BC
Authorized Official - Phone:786-259-2966
Mailing Address - Street 1:311 NE 8TH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4734
Mailing Address - Country:US
Mailing Address - Phone:305-363-5573
Mailing Address - Fax:786-622-1893
Practice Address - Street 1:311 NE 8TH ST STE 109
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4734
Practice Address - Country:US
Practice Address - Phone:305-363-5573
Practice Address - Fax:786-622-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty