=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144129990
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FREEDOM HOMES RECOVERY CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2026
-----------------------------------------------------
Last Update Date | 11/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6310 MABELVALE PIKE
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72209-2130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-454-4143
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 94246
-----------------------------------------------------
City | NORTH LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72190-4246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-454-4143
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BOARD MEMBER
-----------------------------------------------------
Name | LAWRENCE RUSSELL CAUGHRON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-454-4143
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------