| Elai Freed Llc | |
|
2111 E Wooster St Ste A Bowling Green OH 43402-9083 | |
| (419) 315-5736 | |
| Not Available |
| Full Name | Elai Freed Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2111 E Wooster St Ste A, Bowling Green, Ohio |
| Authorized Official Name and Position | Elai Freed (OWNER) |
| Authorized Official Contact | 4193155736 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elai Freed Llc 2111 E Wooster St Ste A Bowling Green OH 43402-9083 Ph: () - | Elai Freed Llc 2111 E Wooster St Ste A Bowling Green OH 43402-9083 Ph: (419) 315-5736 |
| NPI Number | 1073398806 |
|---|---|
| Provider Enumeration Date | 08/29/2023 |
| Last Update Date | 04/15/2024 |
| Certification Date | 04/15/2024 |
| Medicare PECOS PAC ID | 6406291590 |
|---|---|
| Medicare Enrollment ID | O20240729003880 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073398806 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Elai Freed |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669093035 PECOS PAC ID: 4688011380 Enrollment ID: I20240318000694 |
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