Provider Demographics
NPI:1225383326
Name:FREEDOM HOUSE USA, LLC
Entity Type:Organization
Organization Name:FREEDOM HOUSE USA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-746-8232
Mailing Address - Street 1:440 S FEDERAL HWY
Mailing Address - Street 2:UNIT 106
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-4114
Mailing Address - Country:US
Mailing Address - Phone:954-746-8232
Mailing Address - Fax:
Practice Address - Street 1:440 S FEDERAL HWY
Practice Address - Street 2:UNIT 106
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4114
Practice Address - Country:US
Practice Address - Phone:954-746-8232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800027129291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory