| Free Life Wellness Center Llc | |
|
1731 W Baseline Rd Ste 113 Mesa AZ 85202-5782 | |
| (480) 687-1773 | |
| (480) 687-2986 |
| Full Name | Free Life Wellness Center Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1731 W Baseline Rd Ste 113, Mesa, Arizona |
| Authorized Official Name and Position | Courtney Starr Gooch (CEO) |
| Authorized Official Contact | 4806871773 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Free Life Wellness Center Llc 1731 W Baseline Rd Ste 113 Mesa AZ 85202-5782 Ph: (480) 687-1773 | Free Life Wellness Center Llc 1731 W Baseline Rd Ste 113 Mesa AZ 85202-5782 Ph: (480) 687-1773 |
| NPI Number | 1316539687 |
|---|---|
| Provider Enumeration Date | 02/09/2021 |
| Last Update Date | 10/17/2023 |
| Certification Date | 10/03/2023 |
| Medicare PECOS PAC ID | 2961881529 |
|---|---|
| Medicare Enrollment ID | O20220628002341 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316539687 | NPI | - | NPPES |
| 100618 | Medicaid | AZ |
| Provider Name | Marilyn A Staires |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962724799 PECOS PAC ID: 7517082845 Enrollment ID: I20100910000050 |
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