Provider Demographics
NPI:1063452373
Name:FREEDOM HOSPICE, LLC
Entity Type:Organization
Organization Name:FREEDOM HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCKIBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-265-0151
Mailing Address - Street 1:9001 AIRPORT FWY
Mailing Address - Street 2:SUITE 570
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7769
Mailing Address - Country:US
Mailing Address - Phone:817-265-0151
Mailing Address - Fax:817-265-0145
Practice Address - Street 1:9001 AIRPORT FWY
Practice Address - Street 2:SUITE 570
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7769
Practice Address - Country:US
Practice Address - Phone:817-265-0151
Practice Address - Fax:817-265-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009809251G00000X
TX012778251G00000X
TX014560251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
671527Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER