Healthcare Provider Details

I. General information

NPI: 1366356248
Provider Name (Legal Business Name): FREEDOM CARE OF WISCONSIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S EXECUTIVE DR STE 101
BROOKFIELD WI
53005-4216
US

IV. Provider business mailing address

200 S EXECUTIVE DR STE 101
BROOKFIELD WI
53005-4216
US

V. Phone/Fax

Practice location:
  • Phone: 608-677-3200
  • Fax: 608-608-8426
Mailing address:
  • Phone: 608-677-3200
  • Fax: 608-608-8426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

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