Provider Demographics
NPI:1114742053
Name:EPONA WELLNESS, LTD
Entity type:Organization
Organization Name:EPONA WELLNESS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:571-839-5901
Mailing Address - Street 1:15620 24TH AVE N UNIT A
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55447-6487
Mailing Address - Country:US
Mailing Address - Phone:571-839-5901
Mailing Address - Fax:
Practice Address - Street 1:620 MENDELSSOHN AVE N STE 156
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4386
Practice Address - Country:US
Practice Address - Phone:763-373-4187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health