Provider Demographics
NPI:1306058060
Name:FREEDOM ADULT FOSTER CARE CORP.
Entity type:Organization
Organization Name:FREEDOM ADULT FOSTER CARE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SOUHEAVER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:248-625-7923
Mailing Address - Street 1:PO BOX 1588
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48347-1588
Mailing Address - Country:US
Mailing Address - Phone:248-625-7923
Mailing Address - Fax:248-625-1852
Practice Address - Street 1:3990 BIRD RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-1014
Practice Address - Country:US
Practice Address - Phone:248-625-7923
Practice Address - Fax:248-625-1852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities