Provider Demographics
NPI:1750985602
Name:FREEDOM TREK RECOVERY SERVICES INC.
Entity type:Organization
Organization Name:FREEDOM TREK RECOVERY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:DOZIER
Authorized Official - Suffix:
Authorized Official - Credentials:IADC
Authorized Official - Phone:530-319-3109
Mailing Address - Street 1:PO BOX 493640
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-3640
Mailing Address - Country:US
Mailing Address - Phone:530-319-3109
Mailing Address - Fax:
Practice Address - Street 1:1320 YUBA ST STE B11
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1005
Practice Address - Country:US
Practice Address - Phone:530-319-3109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health