Provider Demographics
NPI:1982389664
Name:FREEDOM AT HOME LLC
Entity Type:Organization
Organization Name:FREEDOM AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNELIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-341-4888
Mailing Address - Street 1:51111 WOODWARD AVE STE 765
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-5037
Mailing Address - Country:US
Mailing Address - Phone:734-341-4888
Mailing Address - Fax:
Practice Address - Street 1:51111 WOODWARD AVE STE 765
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-5037
Practice Address - Country:US
Practice Address - Phone:734-341-4888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health