Healthcare Provider Details

I. General information

NPI: 1922300474
Provider Name (Legal Business Name): FREEDOM HOUSE MINISTERIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7044 ANTIOCH
MERRAIM KS
66204
UM

IV. Provider business mailing address

7044 ANTIOCH RD
MERRIAM KS
66204-1246
US

V. Phone/Fax

Practice location:
  • Phone: 913-262-8885
  • Fax:
Mailing address:
  • Phone: 913-262-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number2046
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2046
License Number StateKS

VIII. Authorized Official

Name: MRS. MARILYN THOMAS
Title or Position: FOUNDER/EXECUTIVE DIRECTOR
Credential:
Phone: 913-262-8885