Provider Demographics
NPI:1922467554
Name:FREEDOM CARE LLC
Entity Type:Organization
Organization Name:FREEDOM CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GC & CCO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-989-9710
Mailing Address - Street 1:1979 MARCUS AVE., SUITE C115
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1001
Mailing Address - Country:US
Mailing Address - Phone:718-989-9710
Mailing Address - Fax:718-989-3724
Practice Address - Street 1:1979 MARCUS AVE., SUITE C115
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1001
Practice Address - Country:US
Practice Address - Phone:718-989-9710
Practice Address - Fax:718-989-3724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
NY251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04267378Medicaid
NYA4JJOtherETIN