Healthcare Provider Details

I. General information

NPI: 1093447021
Provider Name (Legal Business Name): HOMETOWN FREEDOM HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N 5TH ST E
RIVERTON WY
82501-4402
US

IV. Provider business mailing address

705 E WASHINGTON AVE
RIVERTON WY
82501-4452
US

V. Phone/Fax

Practice location:
  • Phone: 307-463-0541
  • Fax: 307-463-0494
Mailing address:
  • Phone: 307-463-0541
  • Fax: 307-463-0494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ENEDINA VASCO
Title or Position: EMPLOYEE, OWNER
Credential: C-NP
Phone: 307-463-0541