Healthcare Provider Details

I. General information

NPI: 1487542007
Provider Name (Legal Business Name): FREEDOM CARE OF NEW MEXICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARQUETTE AVE NW STE 1200
ALBUQUERQUE NM
87102-5312
US

IV. Provider business mailing address

1979 MARCUS AVE STE C115
NEW HYDE PARK NY
11042-1126
US

V. Phone/Fax

Practice location:
  • Phone: 505-391-6400
  • Fax: 505-460-8655
Mailing address:
  • Phone: 617-959-4115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH JOHN SMITH
Title or Position: LEAD, NATIONAL EXPANSION
Credential:
Phone: 617-959-4115