1164024238 NPI number — FREELEE INTEGRATED HEALTH WEALTH LLC

Table of content: (NPI 1164024238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164024238 NPI number — FREELEE INTEGRATED HEALTH WEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREELEE INTEGRATED HEALTH WEALTH LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164024238
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3125 NEW CASTLE AVE STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CASTLE
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19720-2174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-277-7161
Provider Business Mailing Address Fax Number:
302-566-2853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3125 NEW CASTLE AVE STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19720-2174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-277-7161
Provider Business Practice Location Address Fax Number:
302-566-2853
Provider Enumeration Date:
11/12/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FREEMAN
Authorized Official First Name:
KEONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/HOLISTIC HEALTH PRACTITIONER
Authorized Official Telephone Number:
302-607-8053

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 405300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 250699919 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".