Healthcare Provider Details

I. General information

NPI: 1861442063
Provider Name (Legal Business Name): FREEDOM PLAZA LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13373 N PLAZA DEL RIO BLVD
PEORIA AZ
85381-4873
US

IV. Provider business mailing address

13373 N PLAZA DEL RIO BLVD
PEORIA AZ
85381-4873
US

V. Phone/Fax

Practice location:
  • Phone: 623-972-1776
  • Fax:
Mailing address:
  • Phone: 623-972-1776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCI-2630
License Number StateAZ

VIII. Authorized Official

Name: BRYAN RICHARDSON
Title or Position: CFO
Credential:
Phone: 615-221-2250