Healthcare Provider Details

I. General information

NPI: 1609047158
Provider Name (Legal Business Name): FREEDOM HOUSE RECOVERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 NEW STATESIDE DR
CHAPEL HILL NC
27516-1165
US

IV. Provider business mailing address

104 NEW STATESIDE DR
CHAPEL HILL NC
27516-1165
US

V. Phone/Fax

Practice location:
  • Phone: 919-942-2803
  • Fax:
Mailing address:
  • Phone: 919-942-2803
  • Fax: 919-942-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOYCE HARPER
Title or Position: CEO
Credential:
Phone: 919-942-2803