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General NPI Number Information
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NPI Number | 1497136279
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Entity Type | Organization
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Legal Business Name | FREEDOM AT HOME, LLC
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Dates
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Enumeration Date | 06/17/2015
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Last Update Date | 06/17/2015
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Provider Practice Location Address
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Address Line | 1226 STOLTZ RD
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City | BETHEL PARK
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State | PA
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Zip | 15102-3782
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Country | US
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Telephone | 412-835-4663
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Fax | 412-835-1233
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Provider Business Mailing Address
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Address Line | 1226 STOLTZ RD
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City | BETHEL PARK
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State | PA
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Zip | 15102-3782
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Country | US
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Telephone | 412-835-4663
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Fax | 412-835-1233
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MRS. MARCIA RENEE MATTHEWS
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Credential | RN
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Telephone | 412-835-4663
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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 | 27833601
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License Number State | PA
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