Provider Demographics
NPI:1497027478
Name:ELEUTHERIA, LLC
Entity Type:Organization
Organization Name:ELEUTHERIA, LLC
Other - Org Name:ELEUTHERIA WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACE
Authorized Official - Suffix:
Authorized Official - Credentials:MS SLP-CCC
Authorized Official - Phone:623-698-5747
Mailing Address - Street 1:13385 W MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2631
Mailing Address - Country:US
Mailing Address - Phone:623-986-5110
Mailing Address - Fax:623-207-9683
Practice Address - Street 1:13385 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2631
Practice Address - Country:US
Practice Address - Phone:623-986-5110
Practice Address - Fax:623-207-9683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5407224Z00000X
225100000X, 225X00000X, 235Z00000X
AZMT14880225700000X
AZ4415225X00000X
AZSLPA75852355S0801X
AZSLP4009235Z00000X
AZSLP5608235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty