Provider Demographics
NPI:1114141165
Name:NEW FREEDOM HEALTHCARE LLC
Entity Type:Organization
Organization Name:NEW FREEDOM HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OTIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-336-0606
Mailing Address - Street 1:1306 STONE ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4522
Mailing Address - Country:US
Mailing Address - Phone:870-336-0606
Mailing Address - Fax:870-336-2265
Practice Address - Street 1:1306 STONE ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4522
Practice Address - Country:US
Practice Address - Phone:870-336-0606
Practice Address - Fax:870-336-2265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR167533716Medicaid
AR167533716Medicaid