Provider Demographics
NPI:1134282080
Name:FREEDOM MANOR, INC.
Entity Type:Organization
Organization Name:FREEDOM MANOR, INC.
Other - Org Name:FREEDOM MANOR - BANDALIER HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-956-5556
Mailing Address - Street 1:2524 E HEATHERBRAE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5668
Mailing Address - Country:US
Mailing Address - Phone:602-956-5556
Mailing Address - Fax:602-957-6556
Practice Address - Street 1:2524 E HEATHERBRAE DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5668
Practice Address - Country:US
Practice Address - Phone:602-956-5556
Practice Address - Fax:602-957-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-362177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ339128OtherPROVIDER ID