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NPI Code Detail

MEDICARE: AURELIA WELLSPRING FREQUENCIES LLC

MEDICARE: AURELIA WELLSPRING FREQUENCIES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
2261QR0400XRehabilitation Clinic/Center

General Provider Information

NPI Number : 1679454177
Entity Type Code : Organization
Provider Name (Legal Business Name) : AURELIA WELLSPRING FREQUENCIES LLC
Provider Business Mailing Address
First Line : 14700 TIREMAN ST APT 2
Second Line :
City : DETROIT
State : MI
Zip : 48228-2757
Country : US
Telephone Number : 313-439-0442
Fax Number :
Provider Business Practice Location Address
First Line : 14700 TIREMAN ST APT 2
Second Line :
City : DETROIT
State : MI
Zip : 48228-2757
Country : US
Telephone Number : 313-439-0442
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JENNIFER L EVON
Credential :
Telephone Number : 313-439-0442
Provider Enumeration Date : 09/10/2025
Last Update Date : 09/10/2025

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