Organization
FREEDOM BRIDGE TO RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY DENISE HENDERSHOT (ADMINISTRATOR)
(270) 791-9943
Entity
Organization
Contact information
Practice address
1307 MAGNOLIA ST, BOWLING GREEN, KY 42104-3050
(270) 791-9943
(270) 904-2377
Mailing address
1307 MAGNOLIA ST, BOWLING GREEN, KY 42104-3050
(270) 791-9943
(270) 904-2377
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194295089
—
KY
Enumeration date
12/04/2018
Last updated
12/13/2018
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