Provider Demographics
NPI:1093389744
Name:FREE STATE HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:FREE STATE HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-647-9049
Mailing Address - Street 1:5 N BENTZ ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4913
Mailing Address - Country:US
Mailing Address - Phone:240-647-9049
Mailing Address - Fax:
Practice Address - Street 1:5 N BENTZ ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4913
Practice Address - Country:US
Practice Address - Phone:240-647-9049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREE STATE HEALTH AND WELLNESS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-17
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty