# ELITE 360 HEALTH AND WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376016410
- **Authorized official:** DANIELL NICOLE LUCAS MT (OWNER)
- **Authorized official phone:** (214) 587-8655

## Contact information

- **Practice address:** 8911 DARTWAY DR, DALLAS, TX 75227-7216
- **Practice address phone:** (214) 587-8655
- **Practice address fax:** (214) 242-9696
- **Mailing address:** 8911 DARTWAY DR, DALLAS, TX 75227-7216
- **Mailing address phone:** (214) 587-8655
- **Mailing address fax:** (214) 242-9696

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0401X | Comprehensive Outpatient Rehabilitation Facility (CORF) | — | NULL | Yes |

## Other

- **Enumeration date:** 01/10/2019
- **Last updated:** 12/15/2022