Provider Demographics
NPI:1609086008
Name:MARY HALL FREEDOM HOUSE, INC.
Entity type:Organization
Organization Name:MARY HALL FREEDOM HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL-GAINER
Authorized Official - Suffix:
Authorized Official - Credentials:NCAC
Authorized Official - Phone:770-642-5500
Mailing Address - Street 1:PO BOX 501205
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31150-1205
Mailing Address - Country:US
Mailing Address - Phone:770-642-5500
Mailing Address - Fax:770-642-5406
Practice Address - Street 1:200 HANNOVER PARK ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-1803
Practice Address - Country:US
Practice Address - Phone:770-642-5500
Practice Address - Fax:770-642-5406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-499-D324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility