Provider Demographics
NPI:1013782879
Name:FREEDOM BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:FREEDOM BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:BETTY
Authorized Official - Last Name:FANFAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:203-820-7700
Mailing Address - Street 1:5381 NW 41ST WAY
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-5028
Mailing Address - Country:US
Mailing Address - Phone:203-820-7700
Mailing Address - Fax:
Practice Address - Street 1:5381 NW 41ST WAY
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-5028
Practice Address - Country:US
Practice Address - Phone:203-820-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children