MEDICARE: FREEDOM HOSPICE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	120122031	IN

General Provider Information

NPI Number	:	1427395946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM HOSPICE, LLC

Provider Business Mailing Address
First Line	:	7215 E 21ST ST STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-1777
Country	:	US
Telephone Number	:	463-202-2926
Fax Number	:	463-202-2176

Provider Business Practice Location Address
First Line	:	7215 E 21ST ST STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-1777
Country	:	US
Telephone Number	:	463-202-2926
Fax Number	:	463-202-2176

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. ELLY LATINIK
Credential	:
Telephone Number	:	847-864-4901

Provider Enumeration Date	:	01/04/2013
Last Update Date	:	11/10/2020

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