Fort Freedom, Inc.

Primary specialty

VA Clinic/CenterTaxonomy code 261QV0200X

Legal business name

FORT FREEDOM, INC.

Practice address

400 Chesterfield Pkwy
Malvern, PA 19355-7700

Phone

(561) 208-1853

NPI assigned

Aug 12, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jonathan Gervasi

Title

Marketing Director

Phone

(626) 390-4080

Specialties & licenses 1

Addresses

Other names 1

• Jonathan Gervasi Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1754956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754956800000",
    "number": "1306722830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636",
            "city": "PORT SALERNO",
            "state": "FL",
            "postal_code": "349920636",
            "telephone_number": "626-390-4080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 CHESTERFIELD PKWY",
            "city": "MALVERN",
            "state": "PA",
            "postal_code": "193557700",
            "telephone_number": "561-208-1853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT FREEDOM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-12",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-12",
        "status": "A",
        "authorized_official_last_name": "GERVASI",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "MARKETING DIRECTOR",
        "authorized_official_telephone_number": "626-390-4080",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QV0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, VA",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jonathan Gervasi",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• William Alan Fine, PHARMD, RPH
• Mark B. Fishtein, D.O.
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• Samantha Foreman, PSYD
• Brian Foster, RCEP
• Robert Frankel, M.D.
• Mae Ennis Frawley
• Anna Pierce Frederick, MSSW, LCSW
• Robin B Frees, BA, CHT, IBCLC

• VA Clinic/Center in Malvern, PA
• Providers in Malvern, PA by specialty
• VA Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.