Provider Demographics
NPI:1134284755
Name:FREEDOM MEMORIAL IN-HOME MONITORING
Entity Type:Organization
Organization Name:FREEDOM MEMORIAL IN-HOME MONITORING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:HOLLIFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-765-1685
Mailing Address - Street 1:PO BOX 163
Mailing Address - Street 2:
Mailing Address - City:SPRUCE PINE
Mailing Address - State:NC
Mailing Address - Zip Code:28777-0163
Mailing Address - Country:US
Mailing Address - Phone:828-765-1685
Mailing Address - Fax:
Practice Address - Street 1:1422 ROAN ROAD
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777
Practice Address - Country:US
Practice Address - Phone:828-765-1685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409225Medicaid