Provider Demographics
NPI:1922883925
Name:FREEDOM LLC
Entity Type:Organization
Organization Name:FREEDOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-769-2707
Mailing Address - Street 1:244 SILVER GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-2470
Mailing Address - Country:US
Mailing Address - Phone:508-769-2707
Mailing Address - Fax:
Practice Address - Street 1:4131 UNIVERSITY BLVD S STE 10
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4346
Practice Address - Country:US
Practice Address - Phone:508-769-2707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health