Healthcare Provider Details

I. General information

NPI: 1568226389
Provider Name (Legal Business Name): FREEDOM RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 ALLENBY DR
MARYSVILLE OH
43040-9355
US

IV. Provider business mailing address

4998 W BROAD ST STE 104
COLUMBUS OH
43228-1647
US

V. Phone/Fax

Practice location:
  • Phone: 937-738-2527
  • Fax:
Mailing address:
  • Phone: 614-754-8051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JESSIE COSTLEY
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 443-839-6928