| Friends Of Freedom House Inc. | |
|
404 Lake Front Drive Russellville AR 72802 | |
| (479) 968-7086 | |
| Not Available |
| Full Name | Friends Of Freedom House Inc. |
|---|---|
| Speciality | Counselor |
| Location | 404 Lake Front Drive, Russellville, Arkansas |
| Authorized Official Name and Position | Stephanie Garner (CEO) |
| Authorized Official Contact | 4792195292 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Friends Of Freedom House Inc. 404 Lake Front Drive Russellville AR 72802 Ph: () - | Friends Of Freedom House Inc. 404 Lake Front Drive Russellville AR 72802 Ph: (479) 968-7086 |
| NPI Number | 1316587850 |
|---|---|
| Provider Enumeration Date | 01/13/2020 |
| Last Update Date | 07/02/2020 |
| Certification Date | 07/02/2020 |
| Medicare PECOS PAC ID | 7012357387 |
|---|---|
| Medicare Enrollment ID | O20240503000372 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316587850 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Summer Prado |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972749133 PECOS PAC ID: 2860832144 Enrollment ID: I20240503000644 |
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