Healthcare Provider Details

I. General information

NPI: 1336052380
Provider Name (Legal Business Name): ELITE BODY ESSENTIALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697A ROUTE 202
GREENE ME
04236-4200
US

IV. Provider business mailing address

697A ROUTE 202
GREENE ME
04236-4200
US

V. Phone/Fax

Practice location:
  • Phone: 207-946-2323
  • Fax:
Mailing address:
  • Phone: 207-946-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CANDICE GRAY
Title or Position: HAIR REPLACEMENT SPECIALIST
Credential:
Phone: 207-713-4507