Basic Information
| Provider Information | |||||||||
| NPI: | 1033697099 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASPEN INVESTMENT GROUP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FREEDOM DETOX CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 119 TUNNEL RD STE B | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288051800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283501000 | ||||||||
| FaxNumber: | 8339130081 | ||||||||
| Practice Location | |||||||||
| Address1: | 1089 X RAY DR | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044050908 | ||||||||
| FaxNumber: | 8667603381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2018 | ||||||||
| LastUpdateDate: | 05/05/2020 | ||||||||
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| AuthorizedOfficialLastName: | HUSTED | ||||||||
| AuthorizedOfficialFirstName: | CHAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8283501000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ASPEN INVESTMENT GROUP | ||||||||
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| NPICertificationDate: | 05/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.