Healthcare Provider Details

I. General information

NPI: 1023394186
Provider Name (Legal Business Name): FREE WILL BAPTIST FAMILY MINISTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 03/10/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 STANLEY LANE
GREENEVILLE TN
37743
US

IV. Provider business mailing address

90 STANLEY LN
GREENEVILLE TN
37743-6066
US

V. Phone/Fax

Practice location:
  • Phone: 423-639-9449
  • Fax: 423-639-5083
Mailing address:
  • Phone: 423-639-9449
  • Fax: 423-639-5083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberSO10855A
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License NumberL000000007820
License Number StateTN

VIII. Authorized Official

Name: MS. CHERYL ANN HENRY
Title or Position: CHIEF OPERATING OFFICER
Credential: R.N.
Phone: 423-639-9449