Provider Demographics
NPI:1275589988
Name:MOBILE FREEDOM LLC
Entity Type:Organization
Organization Name:MOBILE FREEDOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES CEO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:VENEROSE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:724-981-2165
Mailing Address - Street 1:940 NORTH HERMITAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148
Mailing Address - Country:US
Mailing Address - Phone:724-981-2165
Mailing Address - Fax:724-981-2857
Practice Address - Street 1:940 NORTH HERMITAGE ROAD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148
Practice Address - Country:US
Practice Address - Phone:724-981-2165
Practice Address - Fax:724-981-2857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014298120001Medicaid
OH2603810OtherMEDICAID
WV38100041168861OtherMEDICAID
NY02672599Medicaid
PA1014298120001Medicaid
PA1014298120001Medicaid