MEDICARE: ATHOS 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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1265059497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHOS WELLNESS LLC

Provider Business Mailing Address
First Line	:	1340 CHARLES RD
Second Line	:
City	:	JEFFERSON TOWNSHIP
State	:	PA
Zip	:	18436-3415
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 CHARLES RD
Second Line	:
City	:	JEFFERSON TOWNSHIP
State	:	PA
Zip	:	18436-3415
Country	:	US
Telephone Number	:	570-851-7023
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEAN ELEFTHERAKIS
Credential	:	L.AC. DIPL. OM
Telephone Number	:	570-851-7023

Provider Enumeration Date	:	07/03/2020
Last Update Date	:	07/10/2020

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