Provider Demographics
NPI:1831576198
Name:BEFREE CENTERS LLC
Entity type:Organization
Organization Name:BEFREE CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MG MBR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN
Authorized Official - Phone:859-967-9486
Mailing Address - Street 1:2387 PROFESSIONAL HEIGHTS DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503
Mailing Address - Country:US
Mailing Address - Phone:859-967-9486
Mailing Address - Fax:859-368-7780
Practice Address - Street 1:2387 PROFESSIONAL HEIGHTS DR
Practice Address - Street 2:SUITE 10
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3004
Practice Address - Country:US
Practice Address - Phone:859-967-9486
Practice Address - Fax:859-368-7780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002772363L00000X
KY207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPENDINGMedicaid