1952808867 NPI number — MY FREEDOM QUEST, INC.

Table of content: (NPI 1952808867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952808867 NPI number — MY FREEDOM QUEST, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MY FREEDOM QUEST, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952808867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1412 OAK PL APT G
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APOPKA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32712-1901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-718-6960
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2989 W SR 434 STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32779-4898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-786-1913
Provider Business Practice Location Address Fax Number:
407-960-2636
Provider Enumeration Date:
04/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BUTKINS
Authorized Official First Name:
PETER
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
407-718-6960

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  000755 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NPI . This is a "NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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