Provider Demographics
NPI:1164797593
Name:FREEDOM HOME DIALYSIS
Entity Type:Organization
Organization Name:FREEDOM HOME DIALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:DOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:617-529-1023
Mailing Address - Street 1:288 KING ST
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1620
Mailing Address - Country:US
Mailing Address - Phone:617-529-1023
Mailing Address - Fax:
Practice Address - Street 1:288 KING STREET
Practice Address - Street 2:
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025
Practice Address - Country:US
Practice Address - Phone:617-529-1023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment