Provider Demographics
NPI:1720131220
Name:FREEDOMHOUSE RECOVERY CENTER
Entity type:Organization
Organization Name:FREEDOMHOUSE RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JANAKI
Authorized Official - Middle Name:
Authorized Official - Last Name:NICASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-942-2803
Mailing Address - Street 1:104 NEW STATESIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-1165
Mailing Address - Country:US
Mailing Address - Phone:919-942-2803
Mailing Address - Fax:
Practice Address - Street 1:104 NEW STATESIDE DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-1165
Practice Address - Country:US
Practice Address - Phone:919-942-2803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSIGHT HUMAN SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-19
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMHL-093-058OtherDHSR