Healthcare Provider Details

I. General information

NPI: 1790879534
Provider Name (Legal Business Name): NEW FREEDOM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SKYWAY
ATCHISON KS
66002
US

IV. Provider business mailing address

PO BOX 18 1600 SKYWAY
ATCHISON KS
66002
US

V. Phone/Fax

Practice location:
  • Phone: 913-367-0411
  • Fax: 913-367-1517
Mailing address:
  • Phone: 913-367-0411
  • Fax: 913-367-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number185
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier10001620400
Identifier TypeOTHER
Identifier State
Identifier IssuerCOMMUNITY HEALTH PLAN
# 2
Identifier314150
Identifier TypeOTHER
Identifier State
Identifier IssuerHMS VALUE OPTIONS

VIII. Authorized Official

Name: MR. DENIS W VINYARD
Title or Position: DIRECTOR
Credential: BS MDIV CADC1
Phone: 913-367-0411