Provider Demographics
NPI:1447429642
Name:FREEDOM MOBILITY CENTER, LLC
Entity Type:Organization
Organization Name:FREEDOM MOBILITY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:BREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-799-9920
Mailing Address - Street 1:586 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:RODEO
Mailing Address - State:CA
Mailing Address - Zip Code:94572-1450
Mailing Address - Country:US
Mailing Address - Phone:510-799-9920
Mailing Address - Fax:510-799-9930
Practice Address - Street 1:586 PARKER AVE
Practice Address - Street 2:
Practice Address - City:RODEO
Practice Address - State:CA
Practice Address - Zip Code:94572-1450
Practice Address - Country:US
Practice Address - Phone:510-799-9920
Practice Address - Fax:510-799-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1447429642Medicaid
CA6198380001Medicare NSC