Healthcare Provider Details

I. General information

NPI: 1922883925
Provider Name (Legal Business Name): FREEDOM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 UNIVERSITY BLVD S STE 10
JACKSONVILLE FL
32216-4346
US

IV. Provider business mailing address

244 SILVER GLEN AVE
SAINT AUGUSTINE FL
32092-2470
US

V. Phone/Fax

Practice location:
  • Phone: 508-769-2707
  • Fax:
Mailing address:
  • Phone: 508-769-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BORIS BERGUS
Title or Position: CEO
Credential: MD
Phone: 508-769-2707