Provider Demographics
NPI:1760199558
Name:FREEDOM RECOVERY, LLC
Entity Type:Organization
Organization Name:FREEDOM RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-570-5907
Mailing Address - Street 1:205 GRAYSON ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-6231
Mailing Address - Country:US
Mailing Address - Phone:318-570-5907
Mailing Address - Fax:318-654-4957
Practice Address - Street 1:205 GRAYSON ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-6231
Practice Address - Country:US
Practice Address - Phone:318-570-5907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA88-2256058Medicaid