Basic Information
| Provider Information | |||||||||
| NPI: | 1619414232 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FREEDOM BEHAVIORAL HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 GERMANTOWN PIKE | ||||||||
| Address2: | BLDG G-5 | ||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194622480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109413390 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4612 E STREET RD | ||||||||
| Address2: | |||||||||
| City: | TREVOSE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190536612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2676993000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2017 | ||||||||
| LastUpdateDate: | 01/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | FABIANI | ||||||||
| AuthorizedOfficialFirstName: | CESAR | ||||||||
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| AuthorizedOfficialTitleorPosition: | SUBOXONE MAINTENANCE DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 1267699300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302F00000X | Y | Managed Care Organizations | Exclusive Provider Organization |
No ID Information.