Provider Demographics
NPI:1639734718
Name:GIFT OF FREEDOM RECOVERY CENTER
Entity Type:Organization
Organization Name:GIFT OF FREEDOM RECOVERY CENTER
Other - Org Name:GIFT OF FREEDOM WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MCAP, EDD
Authorized Official - Phone:954-805-0177
Mailing Address - Street 1:1225 E RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-3635
Mailing Address - Country:US
Mailing Address - Phone:772-971-6417
Mailing Address - Fax:888-293-5884
Practice Address - Street 1:8241 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-2848
Practice Address - Country:US
Practice Address - Phone:772-971-6417
Practice Address - Fax:888-293-5884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-04
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder