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General NPI Number Information
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NPI Number | 1619414232
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Entity Type | Organization
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Legal Business Name | FREEDOM BEHAVIORAL HEALTHCARE
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 4612 E STREET RD
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City | TREVOSE
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State | PA
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Zip | 19053-6612
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Country | US
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Telephone | 267-699-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 GERMANTOWN PIKE BLDG G-5
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462-2480
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Country | US
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Telephone | 610-941-3390
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Fax |
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Authorized Official
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Title or Position | SUBOXONE MAINTENANCE DOCTOR
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Name | DR. CESAR FABIANI
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Credential | MD
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Telephone | 126-769-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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