Provider Demographics
NPI:1952655391
Name:AMERICAN FREEDOM
Entity Type:Organization
Organization Name:AMERICAN FREEDOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LINCOLN
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-278-5744
Mailing Address - Street 1:P.O. BOX 57
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:WV
Mailing Address - Zip Code:26560-0057
Mailing Address - Country:US
Mailing Address - Phone:304-278-5744
Mailing Address - Fax:304-278-5744
Practice Address - Street 1:5 MANCHIN STREET
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:WV
Practice Address - Zip Code:26560-0057
Practice Address - Country:US
Practice Address - Phone:304-278-5744
Practice Address - Fax:304-278-5744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2244-5543332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies