| Freedom Recovery Center Llc | |
|
10215 214th Ave E Bonney Lake WA 98391-3909 | |
| (253) 862-7374 | |
| (253) 862-0448 |
| Full Name | Freedom Recovery Center Llc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 10215 214th Ave E, Bonney Lake, Washington |
| Authorized Official Name and Position | Robert W Long (PROVIDER/OWNER) |
| Authorized Official Contact | 2538627374 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Freedom Recovery Center Llc 10215 214th Ave E Bonney Lake WA 98391-3909 Ph: (253) 862-7374 | Freedom Recovery Center Llc 10215 214th Ave E Bonney Lake WA 98391-3909 Ph: (253) 862-7374 |
| NPI Number | 1487884441 |
|---|---|
| Provider Enumeration Date | 07/23/2009 |
| Last Update Date | 02/28/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487884441 | NPI | - | NPPES |
| CP00002606 | Other | WA | COUNSELOR REGISTRATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | CP0002606 (Washington) | Primary |
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