MEDICARE: FREEMAN ENRICHMENT CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253J00000X	Foster Care Agency		NV

General Provider Information

NPI Number	:	1225366404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEMAN ENRICHMENT CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 11146
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90749-1146
Country	:	US
Telephone Number	:	310-763-1660
Fax Number	:	310-886-3258

Provider Business Practice Location Address
First Line	:	3013 BLUSH NOISETTE AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-6443
Country	:	US
Telephone Number	:	702-767-4654
Fax Number	:	310-886-3258

Authorized Official
Title or Position	:	PRESIDENT OF BOARD
Name	:	DR. CECILIA JEFFERSON FREEMAN
Credential	:	PH.D.
Telephone Number	:	310-763-1660

Provider Enumeration Date	:	11/25/2009
Last Update Date	:	11/25/2009

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