Provider Demographics
NPI:1225740277
Name:FREEDOM ROCK FAMILY ESTATES INC
Entity Type:Organization
Organization Name:FREEDOM ROCK FAMILY ESTATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHYLON
Authorized Official - Middle Name:E
Authorized Official - Last Name:LONG-MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-306-3052
Mailing Address - Street 1:22552 RESTFUL LN
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-3375
Mailing Address - Country:US
Mailing Address - Phone:573-774-3738
Mailing Address - Fax:
Practice Address - Street 1:22552 RESTFUL LN
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-3375
Practice Address - Country:US
Practice Address - Phone:573-774-3738
Practice Address - Fax:573-774-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children