=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447429642
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FREEDOM MOBILITY CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2008
-----------------------------------------------------
Last Update Date | 10/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 586 PARKER AVE
-----------------------------------------------------
City | RODEO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94572-1450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-799-9920
-----------------------------------------------------
Fax | 510-799-9930
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 586 PARKER AVE
-----------------------------------------------------
City | RODEO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94572-1450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-799-9920
-----------------------------------------------------
Fax | 510-799-9930
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | DAVID FRANK BREEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-799-9920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------