MEDICARE: HOMETOWN FREEDOM HEALTHCARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QP2300X	Primary Care Clinic/Center
4	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1093447021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMETOWN FREEDOM HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	705 E WASHINGTON AVE
Second Line	:
City	:	RIVERTON
State	:	WY
Zip	:	82501-4452
Country	:	US
Telephone Number	:	307-463-0541
Fax Number	:	307-463-0494

Provider Business Practice Location Address
First Line	:	103 N 5TH ST E
Second Line	:
City	:	RIVERTON
State	:	WY
Zip	:	82501-4402
Country	:	US
Telephone Number	:	307-463-0541
Fax Number	:	307-463-0494

Authorized Official
Title or Position	:	EMPLOYEE, OWNER
Name	:	ENEDINA VASCO
Credential	:	C-NP
Telephone Number	:	307-463-0541

Provider Enumeration Date	:	06/28/2022
Last Update Date	:	06/09/2026

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