Organization
FREEDOM CO-OP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TOM NUNNIKHOVEN (BOARD CHAIR)
(901) 833-9744
Entity
Organization
Contact information
Practice address
1633 MADISON AVE, MEMPHIS, TN 38104-2506
(901) 726-6404
Mailing address
1633 MADISON AVE, MEMPHIS, TN 38104-2506
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
L000000009711
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G29
—
TN
Enumeration date
11/13/2011
Last updated
11/13/2011
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