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General NPI Number Information
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NPI Number | 1033519327
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Entity Type | Organization
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Legal Business Name | FREEDOM RECOVERY CENTER LLC
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Dates
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Enumeration Date | 08/25/2014
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 62 DIVISION ST
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City | COLDWATER
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State | MI
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Zip | 49036-1998
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Country | US
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Telephone | 517-278-4673
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Fax | 517-279-4673
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Provider Business Mailing Address
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Address Line | 62 DIVISION ST
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City | COLDWATER
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State | MI
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Zip | 49036-1998
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Country | US
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Telephone | 517-278-4673
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Fax | 517-924-1210
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | RANDY LEVITON
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Credential |
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Telephone | 517-278-4673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | SA0120018
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License Number State | MI
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