Healthcare Provider Details

I. General information

NPI: 1023920741
Provider Name (Legal Business Name): PRIME FREEDOM SOBER HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9836 MALLARD DR
LAUREL MD
20708-3134
US

IV. Provider business mailing address

9836 MALLARD DR
LAUREL MD
20708-3134
US

V. Phone/Fax

Practice location:
  • Phone: 301-675-5755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: HELEN KEMBUMBARA
Title or Position: CEO
Credential:
Phone: 301-675-5755