Provider Demographics
NPI:1912772211
Name:ELWC SERVICES LLC
Entity type:Organization
Organization Name:ELWC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-366-8636
Mailing Address - Street 1:101 SE DWIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-2605
Mailing Address - Country:US
Mailing Address - Phone:954-366-8636
Mailing Address - Fax:
Practice Address - Street 1:2950 NW 62ND ST STE 122
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1702
Practice Address - Country:US
Practice Address - Phone:954-366-8636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMBRACING LOVE WITH CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory