Provider Demographics
NPI:1528401072
Name:FREEDOM RECOVERY CENTER, LLC.
Entity Type:Organization
Organization Name:FREEDOM RECOVERY CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:JESKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-379-0075
Mailing Address - Street 1:PO BOX 2704
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86302-2704
Mailing Address - Country:US
Mailing Address - Phone:928-379-0075
Mailing Address - Fax:855-379-3977
Practice Address - Street 1:1470 W GURLEY ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-2855
Practice Address - Country:US
Practice Address - Phone:928-379-0075
Practice Address - Fax:855-379-3977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4228261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder