Healthcare Provider Details

I. General information

NPI: 1861159238
Provider Name (Legal Business Name): FREEDOM RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2021
Last Update Date: 03/02/2024
Certification Date: 03/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 GARRETT WAY STE 47
POCATELLO ID
83201-5132
US

IV. Provider business mailing address

1800 GARRETT WAY STE 47
POCATELLO ID
83201-5132
US

V. Phone/Fax

Practice location:
  • Phone: 208-252-6464
  • Fax: 208-904-0792
Mailing address:
  • Phone: 208-252-6464
  • Fax: 208-904-0792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHON EISENHOWER HUNT
Title or Position: OWNER
Credential:
Phone: 208-241-9790