Provider Demographics
NPI:1275509143
Name:ALCOHOL AND DRUG FREEDOM CENTER OF KNOX COUNTY
Entity Type:Organization
Organization Name:ALCOHOL AND DRUG FREEDOM CENTER OF KNOX COUNTY
Other - Org Name:FREEDOM CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-397-2660
Mailing Address - Street 1:106 E GAMBIER ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-3510
Mailing Address - Country:US
Mailing Address - Phone:740-397-2660
Mailing Address - Fax:740-392-3613
Practice Address - Street 1:106 E GAMBIER ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-3510
Practice Address - Country:US
Practice Address - Phone:740-397-2660
Practice Address - Fax:740-392-3613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1311101YA0400X
OH01-7560251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35842OtherMBC (MERIT/BIODYNE)
OHOH750732-00OtherNFR ID
OH1311Medicaid
OH729264OtherBWC
OHLICKBO131199OtherPSEUDO UCI
OH45660OtherODADAS AGENCY NUMBER
OH62-15262OtherPHP/UBS NUMBER
OH3908853OtherFDA ID#
OH62-15262OtherUHC OR UBH NUMBER
OHOH750732-00OtherNFR ID
OHOH750732-00OtherNFR ID