MEDICARE: ELOHIM HEALTH AND WELLNESS 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
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114630332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELOHIM HEALTH AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	5700 LAKE WORTH RD STE 209-8
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3275
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 LAKE WORTH RD STE 209-8
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3275
Country	:	US
Telephone Number	:	561-729-9660
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	FRANCESCA DERIUS
Credential	:
Telephone Number	:	561-729-9660

Provider Enumeration Date	:	01/03/2023
Last Update Date	:	01/03/2023

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Directions to “ELOHIM HEALTH AND WELLNESS LLC ” Practice Location

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