=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861828535
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FREEDOM OF CHOICE HEATHCARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2013
-----------------------------------------------------
Last Update Date | 09/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 533 32ND STREET
-----------------------------------------------------
City | UNION CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-766-6617
-----------------------------------------------------
Fax | 201-766-6619
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 533 32ND STREET
-----------------------------------------------------
City | UNION CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-766-6617
-----------------------------------------------------
Fax | 201-766-6619
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | JUANITA WINSLOW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-766-6617
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | 2000567
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number | 2000567
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | 2000567
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------