Provider Demographics
NPI:1306463070
Name:FREEDOM PSYCHIATRY CENTER LLC
Entity type:Organization
Organization Name:FREEDOM PSYCHIATRY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:OKORONKWO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:602-348-1338
Mailing Address - Street 1:7655 W MARY JANE LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3842
Mailing Address - Country:US
Mailing Address - Phone:602-348-1338
Mailing Address - Fax:
Practice Address - Street 1:7075 W BELL RD STE A-1
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8546
Practice Address - Country:US
Practice Address - Phone:602-348-1338
Practice Address - Fax:602-297-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-29
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty