Provider Demographics
NPI:1104250158
Name:BE WELL MY FRIEND LLC
Entity type:Organization
Organization Name:BE WELL MY FRIEND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KENERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:855-239-3556
Mailing Address - Street 1:174 S FREEPORT RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6145
Mailing Address - Country:US
Mailing Address - Phone:855-239-3556
Mailing Address - Fax:207-512-5909
Practice Address - Street 1:174 S FREEPORT RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6145
Practice Address - Country:US
Practice Address - Phone:855-239-3556
Practice Address - Fax:207-512-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty