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NPI Code Detail

MEDICARE: FREEDOM HOUSE SOBER LIVING INC

MEDICARE: FREEDOM HOUSE SOBER LIVING 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
1324500000XSubstance Abuse Rehabilitation Facility324500000XNV

General Provider Information

NPI Number : 1932511698
Entity Type Code : Organization
Provider Name (Legal Business Name) : FREEDOM HOUSE SOBER LIVING INC
Provider Business Mailing Address
First Line : 3852 PALOS VERDES ST
Second Line : SUITE 40
City : LAS VEGAS
State : NV
Zip : 89119-6909
Country : US
Telephone Number : 702-485-1300
Fax Number : 702-485-1210
Provider Business Practice Location Address
First Line : 3852 PALOS VERDES ST
Second Line : SUITE 40
City : LAS VEGAS
State : NV
Zip : 89119-6909
Country : US
Telephone Number : 702-485-1300
Fax Number : 702-485-1210
Authorized Official
Title or Position : CEO
Name : MR. JEFFREY BRIAN IVERSON
Credential :
Telephone Number : 702-279-1298
Provider Enumeration Date : 05/28/2014
Last Update Date : 05/28/2014

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Directions to “FREEDOM HOUSE SOBER LIVING INC ” Practice Location

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