Provider Demographics
NPI:1003034513
Name:HOUSE OF FREEDOM
Entity Type:Organization
Organization Name:HOUSE OF FREEDOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERLLEY
Authorized Official - Middle Name:YAMIRIE
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC, CAP
Authorized Official - Phone:407-957-9077
Mailing Address - Street 1:2311 N ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-2313
Mailing Address - Country:US
Mailing Address - Phone:407-957-9077
Mailing Address - Fax:407-846-8440
Practice Address - Street 1:2311 N ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-2313
Practice Address - Country:US
Practice Address - Phone:407-957-9077
Practice Address - Fax:888-702-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-22
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0749AD495301324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility