MEDICARE: FREEDOM MOBILITY CENTER, 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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447429642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM MOBILITY CENTER, LLC

Provider Business Mailing Address
First Line	:	586 PARKER AVE
Second Line	:
City	:	RODEO
State	:	CA
Zip	:	94572-1450
Country	:	US
Telephone Number	:	510-799-9920
Fax Number	:	510-799-9930

Provider Business Practice Location Address
First Line	:	586 PARKER AVE
Second Line	:
City	:	RODEO
State	:	CA
Zip	:	94572-1450
Country	:	US
Telephone Number	:	510-799-9920
Fax Number	:	510-799-9930

Authorized Official
Title or Position	:	CFO
Name	:	DAVID FRANK BREEN
Credential	:
Telephone Number	:	510-799-9920

Provider Enumeration Date	:	02/21/2008
Last Update Date	:	10/19/2022

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