1922387752 NPI number — FREEDOM IN HOME CARE

Table of content: (NPI 1922387752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922387752 NPI number — FREEDOM IN HOME CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREEDOM IN HOME CARE
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:
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:
1922387752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3110 POLARIS AVE
Provider Second Line Business Mailing Address:
UNIT 26
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89102-8318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-433-1224
Provider Business Mailing Address Fax Number:
702-433-1227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3110 POLARIS AVE
Provider Second Line Business Practice Location Address:
UNIT 26
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89102-8318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-433-1224
Provider Business Practice Location Address Fax Number:
702-433-1227
Provider Enumeration Date:
08/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
SHEENA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
702-433-1224

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  NV20111250975 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 83 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 58 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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