Provider Demographics
NPI:1346512795
Name:FREEDOM HOUSE OF PALM BEACH GARDENS
Entity Type:Organization
Organization Name:FREEDOM HOUSE OF PALM BEACH GARDENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-845-0373
Mailing Address - Street 1:1433 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403
Mailing Address - Country:US
Mailing Address - Phone:561-845-0373
Mailing Address - Fax:561-845-6830
Practice Address - Street 1:1433 10TH ST
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-2041
Practice Address - Country:US
Practice Address - Phone:561-845-0373
Practice Address - Fax:561-845-6830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNAP6013335324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility