Healthcare Provider Details

I. General information

NPI: 1114225927
Provider Name (Legal Business Name): FREEDOM HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4166 LEIDY AVE
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

4166 LEIDY AVE
PHILADELPHIA PA
19104-1039
US

V. Phone/Fax

Practice location:
  • Phone: 215-921-4958
  • Fax: 215-425-5704
Mailing address:
  • Phone: 215-921-4958
  • Fax: 215-425-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CALTON TRACEY LANIER
Title or Position: PRESIDENT
Credential:
Phone: 215-921-4958