Provider Demographics
NPI:1053309948
Name:FREEDOM HOME HEALTH
Entity Type:Organization
Organization Name:FREEDOM HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-336-8870
Mailing Address - Street 1:5930 WILCOX PL
Mailing Address - Street 2:SUITE D
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-6804
Mailing Address - Country:US
Mailing Address - Phone:614-336-8870
Mailing Address - Fax:614-336-8879
Practice Address - Street 1:5930 WILCOX PL
Practice Address - Street 2:SUITE D
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-6804
Practice Address - Country:US
Practice Address - Phone:614-336-8870
Practice Address - Fax:614-336-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH368113251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2613452Medicaid
368113Medicare PIN