Organization
NORTH COUNTRY FREEDOM HOMES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENA MARIE CHIASSON ADVANCED CASAC (EXECUTIVE DIRECTOR)
(315) 379-0139
Entity
Organization
Contact information
Practice address
25 DIES ST, CANTON, NY 13617-1306
(315) 379-0139
(315) 379-1004
Mailing address
25 DIES ST, CANTON, NY 13617-1306
(315) 379-0139
(315) 379-1004
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
UNKNOWN
NOT-FOR-PROFIT
NY
Enumeration date
07/16/2019
Last updated
07/16/2019
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