Healthcare Provider Details

I. General information

NPI: 1104523638
Provider Name (Legal Business Name): FREEDOM-ELITE JOINT VENTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S EDGEWATER LN
SHOREWOOD IL
60404-9540
US

IV. Provider business mailing address

612 S EDGEWATER LN
SHOREWOOD IL
60404-9540
US

V. Phone/Fax

Practice location:
  • Phone: 815-274-1279
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH SPIKER
Title or Position: MANAGING MEMBER
Credential:
Phone: 815-274-1279