Provider Demographics
NPI:1164965364
Name:FREEDOM RESOURCES, LLC
Entity Type:Organization
Organization Name:FREEDOM RESOURCES, LLC
Other - Org Name:INTERIM HEALTHCARE OF SOUTHERN ILLINOIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/AGENCY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZACH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-477-8500
Mailing Address - Street 1:4503 W DEYOUNG ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-0018
Mailing Address - Country:US
Mailing Address - Phone:618-477-8500
Mailing Address - Fax:618-477-8545
Practice Address - Street 1:4503 W DEYOUNG ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-0018
Practice Address - Country:US
Practice Address - Phone:618-477-8500
Practice Address - Fax:618-477-8545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4000537OtherHOME NURSING LICENSE
IL3001520OtherHOME SERVICES LICENSE