Provider Demographics
NPI:1659816668
Name:FREEDOM AT HOME HOMECARE LLC
Entity Type:Organization
Organization Name:FREEDOM AT HOME HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:NICOLLE
Authorized Official - Last Name:WENDT-LISIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-876-0083
Mailing Address - Street 1:26 DOLTON ROAD
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6457
Mailing Address - Country:US
Mailing Address - Phone:215-876-0083
Mailing Address - Fax:215-278-4272
Practice Address - Street 1:6410 A RISING SUN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-5229
Practice Address - Country:US
Practice Address - Phone:215-876-0083
Practice Address - Fax:215-278-4272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103273120Medicaid