=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821778259
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FREENEY REHABILITATIVE CAREER SERVICE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2023
-----------------------------------------------------
Last Update Date | 07/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 457 LAURENCE DR STE 407
-----------------------------------------------------
City | HEATH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75032-2092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-683-7230
-----------------------------------------------------
Fax | 972-357-7910
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 457 LAURENCE DR STE 407
-----------------------------------------------------
City | HEATH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75032-2092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-683-7230
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | GLORIA FREENEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-683-7230
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------