Provider Demographics
NPI:1093447021
Name:HOMETOWN FREEDOM HEALTHCARE, LLC
Entity Type:Organization
Organization Name:HOMETOWN FREEDOM HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENEDINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VASCO
Authorized Official - Suffix:
Authorized Official - Credentials:C-NP
Authorized Official - Phone:307-463-0541
Mailing Address - Street 1:705 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-4452
Mailing Address - Country:US
Mailing Address - Phone:307-463-0541
Mailing Address - Fax:307-463-0494
Practice Address - Street 1:705 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4452
Practice Address - Country:US
Practice Address - Phone:307-463-0541
Practice Address - Fax:307-463-0494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty