Basic Information
| Provider Information | |||||||||
| NPI: | 1093986523 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FREEDOM HOUSE RECOVERY CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 NEW STATESIDE DR | ||||||||
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| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275161165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199422803 | ||||||||
| FaxNumber: | 9199422126 | ||||||||
| Practice Location | |||||||||
| Address1: | 355 S MADISON BLVD | ||||||||
| Address2: | STE C1 | ||||||||
| City: | ROXBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275735485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365998366 | ||||||||
| FaxNumber: | 3363226168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2008 | ||||||||
| LastUpdateDate: | 04/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | HARPER | ||||||||
| AuthorizedOfficialFirstName: | JOYCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9199422803 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 8302253V | 05 | NC | MEDICAID | 8302253H | 05 | NC | MEDICAID | 6006409 | 05 | NC | MEDICAID | 8302253G | 05 | NC | MEDICAID |