| Wholesome Behavioral Health | |
|
115 Golden Gate Pkwy Wentzville MO 63385-7288 | |
| (314) 397-7219 | |
| Not Available |
| Full Name | Wholesome Behavioral Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 115 Golden Gate Pkwy, Wentzville, Missouri |
| Authorized Official Name and Position | Ebitari Fregene (CEO) |
| Authorized Official Contact | 3143977219 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wholesome Behavioral Health 115 Golden Gate Pkwy Wentzville MO 63385-7288 Ph: () - | Wholesome Behavioral Health 115 Golden Gate Pkwy Wentzville MO 63385-7288 Ph: (314) 397-7219 |
| NPI Number | 1467271304 |
|---|---|
| Provider Enumeration Date | 10/08/2024 |
| Last Update Date | 10/08/2024 |
| Medicare PECOS PAC ID | 8628501095 |
|---|---|
| Medicare Enrollment ID | O20241024002100 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467271304 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Ebitari Fregene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003646795 PECOS PAC ID: 4587195177 Enrollment ID: I20241007003380 |
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