Basic Information
| Provider Information | |||||||||
| NPI: | 1336579713 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EL CENTRO DE LIBERTAD/THE FREEDOM CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 ALLERTON ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940631519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505999955 | ||||||||
| FaxNumber: | 6505999273 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 SOUTH CABRILLO HIGHWAY | ||||||||
| Address2: | BUILDING D, SUITE 105 | ||||||||
| City: | HALF MOON BAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940198200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505999955 | ||||||||
| FaxNumber: | 6505999273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2013 | ||||||||
| LastUpdateDate: | 11/20/2013 | ||||||||
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| AuthorizedOfficialLastName: | BORG | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6505999955 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 410026DN | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.