Basic Information
| Provider Information | |||||||||
| NPI: | 1225366404 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FREEMAN ENRICHMENT CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11146 | ||||||||
| Address2: | |||||||||
| City: | CARSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907491146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107631660 | ||||||||
| FaxNumber: | 3108863258 | ||||||||
| Practice Location | |||||||||
| Address1: | 3013 BLUSH NOISETTE AVE | ||||||||
| Address2: | |||||||||
| City: | N LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890816443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027674654 | ||||||||
| FaxNumber: | 3108863258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2009 | ||||||||
| LastUpdateDate: | 11/25/2009 | ||||||||
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| AuthorizedOfficialLastName: | FREEMAN | ||||||||
| AuthorizedOfficialFirstName: | CECILIA | ||||||||
| AuthorizedOfficialMiddleName: | JEFFERSON | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT OF BOARD | ||||||||
| AuthorizedOfficialTelephone: | 3107631660 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253J00000X | NV | Y | Agencies | Foster Care Agency |
No ID Information.