Provider Demographics
NPI:1326690611
Name:NORTH COUNTRY FREEDOM HOMES, INC.
Entity Type:Organization
Organization Name:NORTH COUNTRY FREEDOM HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GENA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CHIASSON
Authorized Official - Suffix:
Authorized Official - Credentials:ADVANCED CASAC
Authorized Official - Phone:315-379-0139
Mailing Address - Street 1:25 DIES ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-1306
Mailing Address - Country:US
Mailing Address - Phone:315-379-0139
Mailing Address - Fax:315-379-1004
Practice Address - Street 1:25 DIES ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1306
Practice Address - Country:US
Practice Address - Phone:315-379-0139
Practice Address - Fax:315-379-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYUNKNOWNOtherNOT-FOR-PROFIT