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General NPI Number Information
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NPI Number | 1497282800
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Entity Type | Organization
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Legal Business Name | FREEDOM VILLA INC
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Dates
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Enumeration Date | 05/16/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3509 ELIZABETH LAKE RD STE 102
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City | WATERFORD
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State | MI
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Zip | 48328-3003
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Country | US
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Telephone | 248-681-3658
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Fax | 248-681-3658
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Provider Business Mailing Address
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Address Line | 3509 ELIZABETH LAKE RD STE 102
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City | WATERFORD
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State | MI
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Zip | 48328-3003
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Country | US
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Telephone | 248-681-3658
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Fax | 248-681-3658
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MS. OLAYEMI SANNI
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Credential | RN
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Telephone | 248-895-7028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | AS630377897
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | AS630299536
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License Number State | MI
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