Organization
FREEDOM RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT WAYNE LONG CDP (ADMINISTRATOR)
(360) 960-8595
Entity
Organization
Contact information
Practice address
715 E YELM AVE STE 6, YELM, WA 98597-8714
(360) 960-8595
(253) 960-8594
Mailing address
715 E YELM AVE STE 6, YELM, WA 98597-8714
(253) 961-0116
(253) 960-8594
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
145800
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
145800
PRIVATE INSURED
WA
Enumeration date
05/18/2017
Last updated
05/18/2017
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