Healthcare Provider Details

I. General information

NPI: 1295653087
Provider Name (Legal Business Name): FREEDOM WAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 31ST ST NE
CEDAR RAPIDS IA
52402-6210
US

IV. Provider business mailing address

5249 N PARK PL NE # 1106
CEDAR RAPIDS IA
52402-6210
US

V. Phone/Fax

Practice location:
  • Phone: 319-250-2970
  • Fax:
Mailing address:
  • Phone: 319-250-2970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. NYTROYANA BLAND
Title or Position: MANAGING MEMBER
Credential: LPN
Phone: 815-482-1050