=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740032556
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRESH SOLUTIONS WELLNESS SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2024
-----------------------------------------------------
Last Update Date | 04/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5245 N UNIVERSITY DR STE A
-----------------------------------------------------
City | LAUDERHILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33351-5017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-213-1619
-----------------------------------------------------
Fax | 954-440-0267
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5245 N UNIVERSITY DR STE A
-----------------------------------------------------
City | LAUDERHILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33351-5017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-213-1619
-----------------------------------------------------
Fax | 954-440-0267
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | ELIMAY L MAXWELL
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 754-213-1619
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------