Organization
FREEDOM HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CALTON TRACEY LANIER (PRESIDENT)
(215) 921-4958
Entity
Organization
Contact information
Practice address
4166 LEIDY AVE, PHILADELPHIA, PA 19104
(215) 921-4958
(215) 425-5704
Mailing address
4166 LEIDY AVE, PHILADELPHIA, PA 19104-1039
(215) 921-4958
(215) 425-5706
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
PA
Other
Enumeration date
03/02/2011
Last updated
03/02/2011
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