MEDICARE: FREEDOM OF CHOICE HEATHCARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	2000567	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821507625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM OF CHOICE HEATHCARE, INC

Provider Business Mailing Address
First Line	:	533 32ND ST
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3910
Country	:	US
Telephone Number	:	201-766-6617
Fax Number	:	201-766-6619

Provider Business Practice Location Address
First Line	:	533 32ND ST
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3910
Country	:	US
Telephone Number	:	201-766-6617
Fax Number	:	201-766-6619

Authorized Official
Title or Position	:	C.E.O.
Name	:	MISS JUANITA WINSLOW
Credential	:	R.N.
Telephone Number	:	201-766-6617

Provider Enumeration Date	:	09/25/2017
Last Update Date	:	07/21/2022

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