Provider Demographics
NPI:1144228081
Name:FREEDOM HOME MEDICAL LLC
Entity Type:Organization
Organization Name:FREEDOM HOME MEDICAL LLC
Other - Org Name:FREEDOM HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:IVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-898-0180
Mailing Address - Street 1:368 GOLD TIP DR
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5165
Mailing Address - Country:US
Mailing Address - Phone:801-898-0180
Mailing Address - Fax:801-229-1675
Practice Address - Street 1:368 GOLD TIP DR
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5165
Practice Address - Country:US
Practice Address - Phone:801-898-0180
Practice Address - Fax:801-229-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0120332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0739565Medicaid
UT203137668001Medicaid
WI82774200Medicaid
MI4964865Medicaid
MI4964865Medicaid
UT203137668001Medicaid