Provider Demographics
NPI:1104035732
Name:FREEDOM HOME CARE INC.
Entity Type:Organization
Organization Name:FREEDOM HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:O
Authorized Official - Last Name:MEHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:909-484-0003
Mailing Address - Street 1:8560 VINEYARD AVE
Mailing Address - Street 2:SUITE # 105
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4349
Mailing Address - Country:US
Mailing Address - Phone:909-484-0003
Mailing Address - Fax:909-484-0026
Practice Address - Street 1:8560 VINEYARD AVE
Practice Address - Street 2:SUITE # 105
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4349
Practice Address - Country:US
Practice Address - Phone:909-484-0003
Practice Address - Fax:909-484-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058276Medicare ID - Type UnspecifiedPROVIDER NUMBER