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General NPI Number Information
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NPI Number | 1063235125
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Entity Type | Organization
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Legal Business Name | FREEDOM CARE OF ILLINOIS LLC
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 125 S WACKER DR STE 300
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City | CHICAGO
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State | IL
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Zip | 60606-4421
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Country | US
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Telephone | 312-971-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 1979 MARCUS AVE STE C115
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1126
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Country | US
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Telephone | 617-959-4115
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Fax |
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Authorized Official
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Title or Position | LEAD, NATIONAL EXPANSION
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Name | MR. KENNETH JOHN SMITH
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Credential | MSM
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Telephone | 617-959-4115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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