Provider Demographics
NPI:1285227868
Name:EASE OF MIND MENTAL HEALTH SOLUTION LLC
Entity Type:Organization
Organization Name:EASE OF MIND MENTAL HEALTH SOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SADAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIRI
Authorized Official - Suffix:
Authorized Official - Credentials:APNP
Authorized Official - Phone:608-381-4976
Mailing Address - Street 1:2976 TRIVERTON PIKE DR STE 225
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5840
Mailing Address - Country:US
Mailing Address - Phone:608-381-4976
Mailing Address - Fax:608-284-7947
Practice Address - Street 1:2976 TRIVERTON PIKE DR # 225
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5840
Practice Address - Country:US
Practice Address - Phone:608-381-4976
Practice Address - Fax:608-284-7947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-15
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100044922Medicaid