Healthcare Provider Details

I. General information

NPI: 1467124891
Provider Name (Legal Business Name): FREEDOM CARE RI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DORRANCE ST STE 700
PROVIDENCE RI
02903-2014
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 718-570-6124
  • Fax:
Mailing address:
  • Phone: 480-330-8855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: KENNETH JOHN SMITH
Title or Position: LEAD, NATIONAL EXPANSION
Credential: MSM
Phone: 718-640-6614