Provider Demographics
NPI:1003412990
Name:FREEDOMCARE LLC
Entity Type:Organization
Organization Name:FREEDOMCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-216-9078
Mailing Address - Street 1:6300 WESTPARK DR STE 130
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-7205
Mailing Address - Country:US
Mailing Address - Phone:832-834-5631
Mailing Address - Fax:832-834-5719
Practice Address - Street 1:6300 WESTPARK DR STE 130
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7205
Practice Address - Country:US
Practice Address - Phone:832-834-5631
Practice Address - Fax:832-834-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20378085OtherDRIVER'S LICENSE