Provider Demographics
NPI:1205827441
Name:FREEDOM HEALTHCARE, LLC
Entity Type:Organization
Organization Name:FREEDOM HEALTHCARE, LLC
Other - Org Name:FREEDOM HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-852-5299
Mailing Address - Street 1:2641 VEACH RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-5579
Mailing Address - Country:US
Mailing Address - Phone:270-852-5299
Mailing Address - Fax:270-852-5290
Practice Address - Street 1:2641 VEACH RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-5579
Practice Address - Country:US
Practice Address - Phone:270-852-5299
Practice Address - Fax:270-852-5290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90011370Medicaid
KY5438940001Medicare NSC