Provider Demographics
NPI:1033519327
Name:FREEDOM RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:FREEDOM RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVITON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-278-4673
Mailing Address - Street 1:62 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1998
Mailing Address - Country:US
Mailing Address - Phone:517-278-4673
Mailing Address - Fax:517-924-1210
Practice Address - Street 1:62 DIVISION ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1998
Practice Address - Country:US
Practice Address - Phone:517-278-4673
Practice Address - Fax:517-279-4673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA0120018324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility