Provider Demographics
NPI:1336318179
Name:FREEMAN HOUSE, INC
Entity Type:Organization
Organization Name:FREEMAN HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KHALILAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHABAZZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-622-1603
Mailing Address - Street 1:2909 E VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504
Mailing Address - Country:US
Mailing Address - Phone:757-622-1603
Mailing Address - Fax:757-622-0758
Practice Address - Street 1:2909 E VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504
Practice Address - Country:US
Practice Address - Phone:757-622-1603
Practice Address - Fax:757-622-0758
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREEMAN HOUSE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-26
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities