Provider Demographics
NPI:1871665737
Name:FREEDOM MOBILITY CENTER, INC.
Entity Type:Organization
Organization Name:FREEDOM MOBILITY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GILBERT
Authorized Official - Last Name:COTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-658-0817
Mailing Address - Street 1:110 TALBERT POINTE DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-4377
Mailing Address - Country:US
Mailing Address - Phone:704-658-0817
Mailing Address - Fax:704-658-0936
Practice Address - Street 1:110 TALBERT POINTE DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-4377
Practice Address - Country:US
Practice Address - Phone:704-658-0817
Practice Address - Fax:704-658-0936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600390323332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703634Medicaid
NCDM1138Medicaid
NC804069OtherPARTNER'S
NC046J3OtherBCBS
NC4615010001Medicare ID - Type Unspecified