Provider Demographics
NPI:1508213174
Name:FREEDOM PROVIDERS LLC
Entity Type:Organization
Organization Name:FREEDOM PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WONSOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-353-2047
Mailing Address - Street 1:3722 MCINTOSH LN
Mailing Address - Street 2:
Mailing Address - City:CARLETON
Mailing Address - State:MI
Mailing Address - Zip Code:48117-9455
Mailing Address - Country:US
Mailing Address - Phone:734-353-2047
Mailing Address - Fax:734-795-6399
Practice Address - Street 1:3722 MCINTOSH LN
Practice Address - Street 2:
Practice Address - City:CARLETON
Practice Address - State:MI
Practice Address - Zip Code:48117-9455
Practice Address - Country:US
Practice Address - Phone:734-353-2047
Practice Address - Fax:734-795-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7945811Medicaid