Provider Demographics
NPI:1386438059
Name:PRIME FREEDOM SOBER HOME LLC
Entity type:Organization
Organization Name:PRIME FREEDOM SOBER HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMBUMBARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-675-5755
Mailing Address - Street 1:12818 ODENS BEQUEST DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5614
Mailing Address - Country:US
Mailing Address - Phone:301-675-5755
Mailing Address - Fax:
Practice Address - Street 1:12818 ODENS BEQUEST DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-5614
Practice Address - Country:US
Practice Address - Phone:301-675-5755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health