=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356972103
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE FREEDOM CENTER, LLC/ GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2020
-----------------------------------------------------
Last Update Date | 01/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 PERRY PKWY STE 5
-----------------------------------------------------
City | GAITHERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20877-2172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-720-3103
-----------------------------------------------------
Fax | 240-306-1471
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 202 PERRY PKWY STE 5
-----------------------------------------------------
City | GAITHERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20877-2172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-720-3103
-----------------------------------------------------
Fax | 240-306-1471
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | JAMES SCRIBNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-720-3103
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------