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General NPI Number Information
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NPI Number | 1215731823
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Entity Type | Organization
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Legal Business Name | FORT FREEDOM, LLC
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 2725 S JONES BLVD STE 104
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City | LAS VEGAS
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State | NV
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Zip | 89146-5605
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Country | US
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Telephone | 702-384-2238
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Fax |
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Provider Business Mailing Address
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Address Line | 2725 S JONES BLVD STE 104
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City | LAS VEGAS
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State | NV
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Zip | 89146-5605
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID E LINDEN
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Credential | MD
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Telephone | 405-840-1999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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