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General NPI Number Information
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NPI Number | 1306598271
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Entity Type | Organization
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Legal Business Name | FREETOWN HEALTH GROUP, LLC
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Dates
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Enumeration Date | 01/21/2022
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 14660 W GELDING DR
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City | SURPRISE
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State | AZ
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Zip | 85379-5752
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Country | US
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Telephone | 623-440-1762
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Fax |
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Provider Business Mailing Address
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Address Line | 11648 W REDFIELD RD
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City | EL MIRAGE
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State | AZ
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Zip | 85335-5948
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Country | US
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Telephone | 240-713-1561
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Fax |
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | HASSAN BUNDU
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Credential |
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Telephone | 240-713-1561
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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 |
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License Number State |
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