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General NPI Number Information
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NPI Number | 1306058060
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Entity Type | Organization
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Legal Business Name | FREEDOM ADULT FOSTER CARE CORP.
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3990 BIRD RD
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City | CLARKSTON
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State | MI
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Zip | 48348-1014
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Country | US
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Telephone | 248-625-7923
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Fax | 248-625-1852
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Provider Business Mailing Address
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Address Line | PO BOX 1588
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City | CLARKSTON
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State | MI
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Zip | 48347-1588
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Country | US
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Telephone | 248-625-7923
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Fax | 248-625-1852
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANNY WAYNE SOUHEAVER SR.
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Credential |
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Telephone | 248-625-7923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | MI
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