Healthcare Provider Details

I. General information

NPI: 1508364860
Provider Name (Legal Business Name): FREEDOM HEALTH INTERVENTIONAL CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6036 N 19TH AVE STE 204
PHOENIX AZ
85015-2104
US

IV. Provider business mailing address

DEPT# 880391 P.O BOX 29650
PHOENIX AZ
85038-9650
US

V. Phone/Fax

Practice location:
  • Phone: 480-626-1746
  • Fax:
Mailing address:
  • Phone: 480-626-1746
  • Fax: 480-626-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREW DOYLE
Title or Position: MANAGER
Credential:
Phone: 480-626-1746