Provider Demographics
NPI:1386241933
Name:FRESH SOLUTIONS WELLNESS SERVICES & CONSULTING, LLC
Entity type:Organization
Organization Name:FRESH SOLUTIONS WELLNESS SERVICES & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIMAY
Authorized Official - Middle Name:LOIS
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:754-213-1619
Mailing Address - Street 1:403 SW 61ST TER
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-1716
Mailing Address - Country:US
Mailing Address - Phone:954-993-1578
Mailing Address - Fax:
Practice Address - Street 1:5245 N UNIVERSITY DR STE A
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-5017
Practice Address - Country:US
Practice Address - Phone:754-213-1619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115481800Medicaid