Healthcare Provider Details

I. General information

NPI: 1619897899
Provider Name (Legal Business Name): FREEDOM HOUSE SOBER LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16485 DARTMOOR CIR
MORENO VALLEY CA
92555-3314
US

IV. Provider business mailing address

16485 DARTMOOR CIR
MORENO VALLEY CA
92555-3314
US

V. Phone/Fax

Practice location:
  • Phone: 951-297-7266
  • Fax:
Mailing address:
  • Phone: 951-297-7266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MORGAN POOLE
Title or Position: CEO
Credential:
Phone: 502-609-1054