Healthcare Provider Details

I. General information

NPI: 1114141165
Provider Name (Legal Business Name): NEW FREEDOM HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 STONE ST
JONESBORO AR
72401-4522
US

IV. Provider business mailing address

1306 STONE ST
JONESBORO AR
72401-4522
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-0606
  • Fax: 870-336-2265
Mailing address:
  • Phone: 870-336-0606
  • Fax: 870-336-2265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. OTIS W WILLEY
Title or Position: OWNER
Credential:
Phone: 870-336-0606