Provider Demographics
NPI:1346750874
Name:FREUDENTHAL HOME HEALTH, LLC
Entity Type:Organization
Organization Name:FREUDENTHAL HOME HEALTH, LLC
Other - Org Name:FREUDENTHAL HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSHONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-387-8881
Mailing Address - Street 1:3105 FREDERICK AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3105 FREDERICK AVE STE D
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3074
Practice Address - Country:US
Practice Address - Phone:816-387-8881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1619222395Medicaid