Provider Demographics
NPI:1114225927
Name:FREEDOM HOUSE
Entity Type:Organization
Organization Name:FREEDOM HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CALTON
Authorized Official - Middle Name:TRACEY
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-921-4958
Mailing Address - Street 1:4166 LEIDY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-1039
Mailing Address - Country:US
Mailing Address - Phone:215-921-4958
Mailing Address - Fax:215-425-5706
Practice Address - Street 1:4166 LEIDY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-921-4958
Practice Address - Fax:215-425-5704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X, 251S00000X
PA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251G00000XAgenciesHospice Care, Community Based
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility