Provider Demographics
NPI:1053825703
Name:FREEDOM HOME CARE, LLC.
Entity Type:Organization
Organization Name:FREEDOM HOME CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VILAYPHONE
Authorized Official - Middle Name:
Authorized Official - Last Name:THAWNGHMUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-327-7630
Mailing Address - Street 1:431 E HANNA AVE STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1486
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7551 SHELBY ST FL 3
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-5980
Practice Address - Country:US
Practice Address - Phone:614-744-9676
Practice Address - Fax:317-744-9824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN014211Medicaid