Provider Demographics
NPI:1609506294
Name:FREE MINDS LLC
Entity Type:Organization
Organization Name:FREE MINDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PEER SUPPORT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAFARI
Authorized Official - Suffix:
Authorized Official - Credentials:CPSS
Authorized Official - Phone:208-246-9902
Mailing Address - Street 1:9618 W MOSSYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-5333
Mailing Address - Country:US
Mailing Address - Phone:208-246-9902
Mailing Address - Fax:
Practice Address - Street 1:9428 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8101
Practice Address - Country:US
Practice Address - Phone:208-246-9902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty