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General NPI Number Information
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NPI Number | 1659493450
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Entity Type | Organization
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Legal Business Name | FREEDOM HOUSE OF LAKELAND, LLC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 5575 FRANKLIN RD
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48301-1158
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Country | US
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Telephone | 248-865-2926
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Fax |
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Provider Business Mailing Address
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Address Line | 26900 FRANKLIN RD.
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City | SOUTHFIELD
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State | MI
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Zip | 48033-5312
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Country | US
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Telephone | 248-350-8070
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Fax |
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Authorized Official
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Title or Position | COO & CFO
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Name | MR. GARY ERNEST ROMANELLI
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Credential |
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Telephone | 248-350-8070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AS630281734
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License Number State | MI
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