Healthcare Provider Details

I. General information

NPI: 1831576198
Provider Name (Legal Business Name): BEFREE CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2387 PROFESSIONAL HEIGHTS DR SUITE 10
LEXINGTON KY
40503-3004
US

IV. Provider business mailing address

2387 PROFESSIONAL HEIGHTS DR SUITE 10
LEXINGTON KY
40503
US

V. Phone/Fax

Practice location:
  • Phone: 859-967-9486
  • Fax: 859-368-7780
Mailing address:
  • Phone: 859-967-9486
  • Fax: 859-368-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3002772
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: LORI WAGNER
Title or Position: MG MBR
Credential: MSN, APRN
Phone: 859-967-9486