Provider Demographics
NPI:1093789943
Name:FREEDOM ACCESS & MOBILITY LLC
Entity Type:Organization
Organization Name:FREEDOM ACCESS & MOBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:V
Authorized Official - Last Name:CONNELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:OWNER
Authorized Official - Phone:304-296-8286
Mailing Address - Street 1:PO BOX 4131
Mailing Address - Street 2:
Mailing Address - City:STAR CITY
Mailing Address - State:WV
Mailing Address - Zip Code:26504
Mailing Address - Country:US
Mailing Address - Phone:304-296-8286
Mailing Address - Fax:304-225-3922
Practice Address - Street 1:1222 GREENBAY RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-296-8286
Practice Address - Fax:304-225-3922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1321160001Medicare ID - Type Unspecified