Provider Demographics
NPI:1790920809
Name:NARCONON FREEDOM CENTER, INC.
Entity Type:Organization
Organization Name:NARCONON FREEDOM CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:TENORIO
Authorized Official - Suffix:
Authorized Official - Credentials:CCDC
Authorized Official - Phone:517-629-8661
Mailing Address - Street 1:809 W ERIE ST
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-1523
Mailing Address - Country:US
Mailing Address - Phone:517-629-8661
Mailing Address - Fax:517-629-6424
Practice Address - Street 1:809 W ERIE ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1523
Practice Address - Country:US
Practice Address - Phone:517-629-8661
Practice Address - Fax:517-629-6424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI130110324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility