=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336874403
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE FREELUX PROJECT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2022
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1777 N RECORD ST APT 3306
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75202-1262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-646-6700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1777 N RECORD ST APT 3306
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75202-1262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-646-6700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. NATHANIEL HOLLEY II
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-646-6700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------