Provider Demographics
NPI:1932511698
Name:FREEDOM HOUSE SOBER LIVING INC
Entity Type:Organization
Organization Name:FREEDOM HOUSE SOBER LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:IVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-279-1298
Mailing Address - Street 1:3852 PALOS VERDES ST
Mailing Address - Street 2:SUITE 40
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6909
Mailing Address - Country:US
Mailing Address - Phone:702-485-1300
Mailing Address - Fax:702-485-1210
Practice Address - Street 1:3852 PALOS VERDES ST
Practice Address - Street 2:SUITE 40
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6909
Practice Address - Country:US
Practice Address - Phone:702-485-1300
Practice Address - Fax:702-485-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV324500000X324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility