Provider Demographics
NPI:1225524242
Name:LIVING FREE HEALTH AND FITNESS A NON-PROFIT CORPORATION
Entity Type:Organization
Organization Name:LIVING FREE HEALTH AND FITNESS A NON-PROFIT CORPORATION
Other - Org Name:LIVING FREE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:POERIO
Authorized Official - Suffix:
Authorized Official - Credentials:LADC-S, LADC, MAC
Authorized Official - Phone:702-600-2527
Mailing Address - Street 1:2050 N. HIGHWAY 160
Mailing Address - Street 2:SUITE 700
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89060
Mailing Address - Country:US
Mailing Address - Phone:775-505-1625
Mailing Address - Fax:775-403-1755
Practice Address - Street 1:2050 N. HIGHWAY 160
Practice Address - Street 2:SUITE 700
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060
Practice Address - Country:US
Practice Address - Phone:775-505-1625
Practice Address - Fax:775-403-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty