| Awake For Life, Llc | |
|
143 N Mccormick St Ste 103 Prescott AZ 86301-2725 | |
| (928) 707-1841 | |
| Not Available |
| Full Name | Awake For Life, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 143 N Mccormick St Ste 103, Prescott, Arizona |
| Authorized Official Name and Position | Nancy Gerlach (OWNER) |
| Authorized Official Contact | 9287071841 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Awake For Life, Llc 143 N Mccormick St Ste 103 Prescott AZ 86301-2725 Ph: (928) 707-1841 | Awake For Life, Llc 143 N Mccormick St Ste 103 Prescott AZ 86301-2725 Ph: (928) 707-1841 |
| NPI Number | 1891487062 |
|---|---|
| Provider Enumeration Date | 05/24/2023 |
| Last Update Date | 05/24/2023 |
| Certification Date | 05/24/2023 |
| Medicare PECOS PAC ID | 2769849421 |
|---|---|
| Medicare Enrollment ID | O20230612001360 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891487062 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Nancy Lynn Gerlach |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710450879 PECOS PAC ID: 4587021241 Enrollment ID: I20230612001400 |
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