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General NPI Number Information
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NPI Number | 1386948354
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Entity Type | Organization
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Legal Business Name | FREEDOM SENIOR SERVICES OF INDIANA, INC.
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 1398 N SHADELAND AVE STE 2231
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-3619
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Country | US
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Telephone | 317-359-3733
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Fax | 317-357-2273
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Provider Business Mailing Address
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Address Line | 1398 N SHADELAND AVE STE 2231
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-3619
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Country | US
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Telephone | 317-359-3733
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Fax | 317-357-2273
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WALTER E JUSTUS
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Credential |
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Telephone | 317-359-3733
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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 | 100124561
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License Number State | IN
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