Provider Demographics
NPI:1306013206
Name:TOTAL FREEDOM HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:TOTAL FREEDOM HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-338-6900
Mailing Address - Street 1:7701 FRANCE AVE S
Mailing Address - Street 2:STE 200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5288
Mailing Address - Country:US
Mailing Address - Phone:651-338-6900
Mailing Address - Fax:952-841-6301
Practice Address - Street 1:7701 FRANCE AVE S
Practice Address - Street 2:STE 200
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5288
Practice Address - Country:US
Practice Address - Phone:651-338-6900
Practice Address - Fax:952-841-6301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-11
Last Update Date:2008-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33550251E00000X
MN335500251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN968478100Medicaid