Provider Demographics
NPI:1235853110
Name:MOUNTAIN FREEDOM CARE LLC
Entity Type:Organization
Organization Name:MOUNTAIN FREEDOM CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:CAIRO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:443-812-6652
Mailing Address - Street 1:4265 WHITNEY PL
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6710
Mailing Address - Country:US
Mailing Address - Phone:443-812-6652
Mailing Address - Fax:
Practice Address - Street 1:4265 WHITNEY PL
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-6710
Practice Address - Country:US
Practice Address - Phone:443-812-6652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)